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!
By Kamil, NIHR Newcastle PSRC Patient, Public Contributor
Lured by the promise of good food and new acquaintances, on Friday 17 October I made my way to Manchester for the NIHR SafetyNet Symposium – a gathering of clinicians, researchers and public contributors united by a single mission: tackling inequities in patient safety. Hosted by the Greater Manchester Patient Safety Research Collaboration (PSRC), the event brought together colleagues from the six PSRCs across England – Central London, Greater Manchester, Midlands, Newcastle, North West London and Yorkshire & Humber.
The day began with coffee and a bustling lobby filled with poster presentations. From the start, it was clear this wasn’t just an academic exercise. It was a collective effort to bridge the gap between policy, practice and lived experience.
One of the first things that struck me was the keynote by Dr Rosie Benneyworth from the Health Services Safety Investigations Body (HSSIB). I hadn’t heard of HSSIB before and I found its mission fascinating. The organisation investigates systemic issues in healthcare topics such as sepsis, prison health and fatigue without focusing on blame. Instead, it looks for learning and improvement. This shift from a ‘who’s to blame’ culture to one of collective accountability resonated deeply with me.
A presentation on avoidable healthcare-associated harm in prisons was another eye-opener. While I wasn’t surprised to hear that prisoners and people experiencing homelessness suffer significantly worse health outcomes, it was sobering to see how these inequities manifest in daily practice e.g. medication shortages, missed appointments and institutional barriers that make basic care difficult. As someone finishing reading a book on health promotion, I could connect the dots between theory and reality: these are not abstract inequalities, they are lived injustices.
One reflection that stayed with me came from a discussion about adoption and breaking cycles of poverty and violence. Even in systems that often feel broken, there are ways to create safety and opportunity through compassion and action.
Several sessions focused on the intersection of communication and safety, including translation and interpreting services. This hit particularly close to home. As a qualified Polish interpreter, I know how vital accurate translation is for patient safety, yet the pay rates offered by NHS providers are often so low that professionals can’t afford to take the work. Hearing that language access was being discussed as a safety issue, not just a convenience, was both encouraging and frustrating. We have the knowledge; now the system needs the will to act.
The Patient Safety Healthcare Inequalities Reduction Framework, presented by Dr Hester Wain, outlined five principles for change: communication and information, training and resources, data, co-production, and research. I was especially struck by her emphasis that the experiences informing the framework are what make it powerful.
By the end of the day, after many conversations in the poster corridor and a moving talk on ethnic inequities in patient safety by Professor Dawn Edge, I left Manchester feeling both hopeful and challenged. The message was clear: health doesn’t happen in a vacuum. Tackling inequity requires empathy, collaboration, and, above all, a commitment to listen to those whose voices are too often ignored. For me, as a patient-cum-public contributor, the symposium was a reminder that my lived experience isn’t just welcome in research – it’s essential.
By Dr Anna Robinson-Barella and Dr Matt Cooper
Along with several of our NIHR Newcastle PSRC colleagues, Matt and I attended the SafetyNet symposium on Friday 17th October in Manchester. The focus of the event was: “Tackling Inequalities in Patient Safety”. It was a day that encouraged a lot of reflection-primarily upon patient safety and our cross-PSRC SafetyNet-agenda, but also upon intersectional influences including ethnicity, marginalisation, and wider EDI-related issues underpinning our work.
We heard from speakers across all six of the PSRCs, as well as two keynote speakers, Dr Rosie Benneyworth presenting “Moving away from a “whose to blame” culture” and Prof Dawn Edge presenting “Ethnic Inequalities in Patient Safety”.
NIHR Newcastle PSRC had 32 of our colleagues in attendance; many of whom presented research posters about their work covering topics like polypharmacy, medicines adherence, costs and treatment decisions, social prescribing, health-related quality of life, and predicting diseases by using AI.
It was also a pleasure to personally contribute to the agenda of the day, and represent NIHR Newcastle PSRC, by presenting an evidence synthesis on inequities affecting medicines access for people experiencing homelessness and the subsequent consequences on their (patient) safety.
Congratulations to all the team involved in organising, hosting and running a great symposium!
by Hiranmayi Madabhushi Hari, Research Assistant, working with Dr Anna Robinson-Barella and Prof Andy Husband.
Hiranmayi Madabhushi Hari, one of our Research Assistants working with Dr Anna Robinson-Barella and Prof Andy Husband, recently attended training about D/deaf awareness. In this reflective blog, Hiranmayi shares a call to action for inclusive research approaches for people who are Deaf and/or Hard of Hearing.
Behind every statistic on deafness (1,2) lies a painful truth: people who are Deaf and Hard of Hearing (HoH) continue to be sidelined in healthcare, research, and everyday life. Deafness is a hidden disability, one you cannot always “see”, yet misconceptions endure. Too often, society clings to inappropriate labels like “deaf & mute/dumb” or “hearing impaired”, “handicapped” terms rooted in stigma. The distinctions between Deaf, deaf, Hard of hearing and Deafblind remain poorly understood, while assumptions that cochlear implants or hearing aids “fix” hearing only deepen isoloaton.
Language matters. Labels must respect individual identity, not reinforce exclusion and a lack of awareness can have very real consequences. Many people cannot lipread, nor do they necessarily know British Sign Language (BSL). Without interpreters, functional hearing loops, or accessible systems, they are left excluded from basic services, including healthcare. For many BSL users and D/deaf people, poor mental health outcomes are a direct consequence of systemic barriers, worsened when communication needs are ignored, interpreters are absent, and accessible systems simply don’t exist. The recent Still Ignores: The fight for Accessible Healthcare report (3) describes this neglect as a “damning indictment”: Deaf patients left without understanding diagnoses, unable to contact their GP, and excluded from safe, equitable care.
These failures spill into research, where D/deaf people are often excluded from clinical trials or overlooked in inclusion criteria. D/deaf awareness, culture, and communication must be embedded in both research design and service delivery. As researchers, we must ask ourselves: are our services and research strategies truly accessible? Do we respect preferred communications? Do we prioritise D/deaf culture in research? Change requires not pity but patience, awareness and urgent action.
References:
- Prevalence of British Sign Language [Internet]. RNID. [cited 2025 Sep 17]. Available from: https://rnid.org.uk/get-involved/research-and-policy/facts-and-figures/prevalence-of-british-sign-language/
- GOV.UK [Internet]. [cited 2025 Sep 17]. The British Sign Language (BSL) report 2022. Available from: https://www.gov.uk/government/publications/the-british-sign-language-bsl-report-2022/the-british-sign-language-bsl-report-2022
- Still ignored: the fight for accessible healthcare. Available from: https://rnid.org.uk/wp-content/uploads/2025/05/Still-ignored-the-fight-for-accessible-healthcare.pdf
