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Invisible Disabilities

Within the Disability History Month, on 3 December, is the International Day for People with Disabilities. This day is sanctioned by the United Nations. The theme this year is invisible disabilities.

Matthew James, NHS North East and Yorkshire Head of Equality and Inclusion is keen to advocate the importance of this theme. We have started to work together to create a resource for our #VirtualCollaborate programme which helps facilitators and technical leads to understand the opportunities for designing a virtual session that is considerate to those with invisible disabilities. 

Matthew shares his thoughts and hopes here for improvement changes that could make a profound difference for people with invisible disabilities. You can also hear more from Matthew in this recording of his presentation for the NHS England and NHS Improvement Wellbeing Series.

Why is the theme of invisible disabilities so relevant?

This theme is very relevant and helpful to where the NHS is in terms of our need to make the workplace as inclusive as possible for our people. The People Plan places a huge amount of importance on the need for the workplace to be culturally compliant so that our people feel safe and fully supported, to thrive. 

What is the main challenge?

The key challenge is that often people do not disclose a disability or long term health condition that they have. In 2020, according to ESR data, in NHS England and NHS Improvement, 5.5% of our people report having a disability or long term health condition, whilst 14.2% are reported as unknown/do not disclose. For NHSE and NHSI in my region (North East and Yorkshire) the number of non-disclosure responses is lower at 8% with 5% reporting to have a disability or long term condition. This falls short against the level of 19% working adults in the UK.

What is the impact of non-disclosure?

Non-disclosures can be used as a potential, albeit crude, indicator of how comfortable our people feel about sharing information on a disability or long term condition that they have, or simply put, how inclusive our workplace is. Whether a member of staff shares information about an invisible disability or long term condition they have within their team, is another matter. But, someone who doesn’t disclose something about themselves that affects them on a day to day basis, may have to endure additional ‘hidden’ pressures/stresses when being part of teams that can inadvertently be unsupportive of their needs. From my experience people do want to support others and there is a lot of kindness in the NHS, but will not have the knowledge of fellow peoples’ differences and their lived experiences, to be able to be supportive and inclusive in return. For example, my interpreter should have a break every 20 minutes but some meetings don't have a break in 90 minutes or more and I often have to be brave and interrupt the meeting to ensure this happens.

How can we change this?

Rather than look at the reasons that someone may resist disclosing a disability or long term health condition, I believe we should do more to understand social aspect of inclusion. If we can all be mindful that we all have different lived experience, and respect them and own up to not knowing much about them in return, then we will find we are all in pretty much the same boat, and have equal differences and challenges in our lives. Making it everyone’s responsibility to relentlessly discuss what inclusion means for them will be the start of a positive process for change. The end benefit will be people feeling they can share their identity freely, without it being questioned, in a workplace climate and environment allows everyone to thrive.

What are your top tips for inclusion during a virtual session?

My top tips are for those designing sessions to think about the eyes, for example, if I am looking away eg writing then I am not following. I am increasingly seeing people using their hands more in virtual session, which is an improvement opportunity to increase the inclusivity for everyone by using signing.

Here's some easy ones to get started with: 

"bye"Wave your hand
"all is well"
Put one thumb up
"very good"
Put two thumbs up
"Time out"
Hold one hand flat and tap with the other hand at a right angle
"Thank you"Flat hand starts with fingertips on chin. Hand moves down and away from yourself.

You can find many more by going to Sign BSL: education or download the App. Simply type in the word and a small video will appear of someone showing you how to sign it.

Picture via Teresa 

This theme of invisible disabilities brings light to those of us who may have a disability or condition that isn’t apparent to others, which we may choose to reveal or hide. They can be wide ranging conditions: sensory loss such as deafness; mental health conditions; neurodiversity, stroke survivors and diabetes, to name a few. If we can improve for those who are deaf and hard of hearing then it will improve for many people too. Matthew James Head of Equality and Inclusion NHS North East and Yorkshire