Disability, Function and Reasonable Adjustments

You may think disability is always visible, that a diagnosis predicts what someone can do, or that adjustments provide an unfair advantage. These assumptions can create barriers to safe care.

Disability is not one type of experience Disability can affect movement, stamina, sight, hearing, communication, learning, memory, concentration, sensory processing or mental health. Some disabilities are apparent to other people. Others are non visible. Some remain stable, while others fluctuate from day to day. People with the same diagnosis can have different abilities, barriers and support needs. A condition may affect one activity greatly and another very little. You should not have to demonstrate distress or dependency before your access needs are taken seriously. Diagnosis, impairment and function are different A diagnosis names a health condition. An impairment describes a difference or loss affecting physical, sensory, cognitive or mental functioning. Function describes what you can do within a particular situation. Function depends partly on the task and environment. For example, you may communicate effectively in a quiet room but struggle in a noisy waiting area. You may walk indoors but require mobility support for longer distances. A functional assessment should therefore ask what you need to do, what is difficult and what could reduce the barrier. Disability does not remove autonomy Do not assume that a disabled person cannot understand information, make decisions, work, parent or live independently. Some people need information presented differently or need additional time. This does not automatically mean that they lack mental capacity. Capacity is specific to the particular decision and time. Communication support and reasonable adjustments should be provided before concluding that someone cannot make a decision. Your clinician should speak directly to you, even when another person assists with communication. Language and identity are personal Some people prefer "disabled person". Others prefer "person with a disability" or condition specific language. There is no universal preference. Use the language a person requests where possible. Avoid language that presents disability as tragedy, inspiration or personal failure. The focus should remain on the person, their goals and any barriers requiring action. The legal definition has a particular purpose Under the Equality Act 2010, disability generally means a physical or mental impairment with a substantial and long term negative effect on normal daily activities. "Substantial" means more than minor or trivial. "Long term" generally means lasting, or likely to last, at least 12 months. Cancer, HIV infection and multiple sclerosis receive protection from diagnosis under specific provisions. The Equality Act applies in England, Scotland and Wales. Northern Ireland has separate disability discrimination legislation. The legal definition is used to establish rights and duties. It should not be used to dismiss support needs that require practical attention. What is a reasonable adjustment? A reasonable adjustment is a change that reduces a disadvantage experienced because of disability. Service providers have a duty to consider reasonable adjustments. This can include changing policies or procedures, addressing physical barriers or providing an aid or service. An adjustment does not guarantee a particular clinical decision. It should make access, communication, examination and treatment more equitable. The adjustment needed depends on the individual. Asking you directly is often the most reliable starting point. Examples within healthcare Reasonable adjustments may include: A longer appointment. An appointment at a quieter time. Step free access. Space for mobility equipment. A British Sign Language interpreter. A hearing loop. Large print, braille, audio or easy read information. Permission for a support person to attend. Extra time to process information. Reduced background noise. Written confirmation after a discussion. Clear directions or visual information before arrival. Flexibility in how an examination is completed. Avoiding telephone only access. Alternative positioning during a procedure. These examples are not an exhaustive list. An effective adjustment responds to your actual barrier rather than making assumptions from your diagnosis. Accessible communication is part of safe care Information must be understandable before you can weigh options or give informed consent. The NHS Accessible Information Standard, revised in June 2025, requires relevant NHS and publicly funded adult social care services to identify, record, flag, share, meet and review disability related information and communication needs. A related Reasonable Adjustment Digital Flag standard, updated in December 2025, is being rolled out across health and care records, with full national compliance expected by 30 September 2026. Not every service will have completed this yet. Communication support may include information in a different format, an interpreter or communication professional, plain language, visual aids, additional processing time, repetition or checking understanding, a communication passport, and a familiar supporter, with your agreement. A relative should not routinely replace a qualified interpreter where accurate, confidential communication is required. Ask for adjustments before care where possible You can tell a service what the barrier is, what has helped before, which communication method you use, whether you need someone to attend. Whether the environment creates sensory or physical difficulty, whether you need information before the appointment, and whether the adjustment is temporary, permanent or variable. Ask for the need and agreed adjustment to be recorded. Review it when your circumstances or preferences change. NHS systems are increasingly designed to record and share reasonable adjustment requirements, reducing repeated explanations across services. Adjustments should support accurate assessment A poorly adapted consultation can produce misleading findings. Pain, sensory overload, communication difficulty or fatigue may affect how you respond. A rushed examination may wrongly suggest that you cannot cooperate or understand. Adjustments can improve diagnostic accuracy by allowing you to communicate symptoms, understand instructions and participate in examination more effectively. Disability does not explain every new symptom A new symptom should not be dismissed as part of an established disability. Examples include: New weakness in a previously unaffected limb. Sudden change in speech or communication. New confusion or marked drowsiness. A sudden decline in mobility. New swallowing difficulty. Unexplained pain. A change in behaviour from your usual pattern. A new inability to complete a familiar task. The change may represent an acute illness, injury, medicine effect or deterioration requiring assessment. Someone who knows you well may help identify a significant change from your baseline. Their observations should be heard without replacing your own account. Function can change without the diagnosis changing Your diagnosis may remain the same while your function improves or declines. Possible influences include pain, fatigue, sleep, mood, infection, medicines, equipment, housing, transport, workplace design, availability of assistance, and confidence after a fall or hospital admission. A functional review should explore these potentially modifiable factors. Independence does not mean doing everything without help Independence means having choice, control and meaningful participation. You may achieve this through equipment, personal assistance, adapted communication or environmental changes. Using support does not make an activity less independent. Support can be the means through which you direct your own life. Responding when an adjustment is not provided Explain clearly the disability related barrier, the adjustment requested, how the adjustment would reduce the disadvantage, what happened when it was not provided, and what action you are requesting now. You can ask the service to review the decision or use its complaints process. Advocacy support may help when communication or power imbalances make this difficult. Immediate clinical needs should still be addressed while an access concern is being resolved.

Disability is shaped by the interaction between an impairment, the activity you need or want to complete, the environment, communication method or service design, and the support or adjustment available. A reasonable adjustment removes or reduces a substantial disadvantage it does not reduce clinical standards.