NHS England » NHS Workforce Disability Equality Standard: 2024 data analysis report for NHS trusts

Access the full version of this report, including a detailed data breakdown.

Context

The NHS Workforce Disability Standard (WDES) is published annually and is an essential tool in supporting the NHS to be an inclusive and fair workplace. It helps evaluate progress and identify areas where further improvement is needed. The 2024 report is the latest version; previous years reports can be found on the NHS England website.

The report uses data from the electronic staff record and the NHS Staff Survey to bring together a national picture of disability across the NHS.

Local data reports are also sent to individual organisations to support them to make improvements. NHS England’s Equality, diversity and inclusion (EDI) improvement plan, published in 2023, is our pathway to support further progress through NHS systems.

The plan sets out 6 actions for systems to consider to create an environment where staff feel they belong, can safely raise concerns, and are empowered to deliver the best care to our patients.

The EDI repository available on NHS Futures (login required) includes examples of best practice from organisations.

Foreword

As we work to make the NHS an inclusive and fair workplace, the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) remain essential tools for evaluating our progress and identifying areas where further improvement is needed.

They provide a critical framework to ensure equality of opportunity is not just something we talk about but is central to our organisational culture, policies and practices.

With nearly 1 in 4 members of our NHS workforce having lived experience of a disability or long-term condition, this year’s WDES report shows evidence of the efforts NHS employers are making to create a fully inclusive workplace for disabled staff and position themselves as the employer of choice for disabled people.

Disabled people are more likely than average to be represented on NHS boards than in the wider workforce and disabled candidates are also more likely to be appointed from interview.

More employers are also making reasonable adjustments that enable disabled staff to carry out their work. 74.5% of disabled staff reported that their employer has made reasonable adjustment(s) to enable them to carry out their work, an increase from 2022.

But disabled staff remain more than twice as likely to be performance managed compared to their non-disabled colleagues, and experienced higher levels of harassment, bullying or abuse from managers and other colleagues.

We know that there is still work to be done to make sure all staff are given equal opportunities to progress in their careers and be free from discrimination, bullying, harassment or abuse from other staff.

The NHS equality, diversity and inclusion improvement plan, published in 2023, is our pathway to further progress – setting out 6 actions to create an environment where staff feel they belong, can safely raise concerns and are empowered to deliver the best care to our patients.

We know that to achieve the goals that will be set out for our staff in the upcoming 10 Year Health Plan, we must enhance the experience of our workforce, improving retention and attracting new talent to the NHS from the widest possible pool.

Dr Navina Evans CBE
Chief Workforce, Training and Education Officer, NHS England

Key findings

In March 2024, 5.7% of the workforce across NHS trusts declared a disability through the Electronic Staff Record (ESR) (86,312 people), which was an increase of 0.8% on 2023.

14.3% of staff did not declare whether they have a disability or not.

5% of board members declared that they have a disability.

The likelihood of non-disabled candidates being appointed from shortlisting compared to disabled candidates was close to equity (0.98).

Specifically, 19.5% of non-disabled candidates were appointed from shortlisting compared with 19.8% of disabled candidates.

Disabled staff were more than twice as likely (2.04) to enter the formal capability process (on performance grounds) compared to their non-disabled colleagues, although this was an improvement from 2.17 in 2023.

Comparable findings from the 2023 NHS Staff Survey:

5% of respondents from NHS trusts indicated they were disabled
5% of disabled staff reported that their employer has made reasonable adjustment(s) to enable them to carry out their work, an increase from 2022 (73.0%)
0% of disabled staff reported experiencing harassment, bulling or abuse by patients, family, service users or the public, 14.6% from managers and 15.4% from other colleagues, lower than in previous years but higher than the experience of non-disabled staff
fewer disabled staff (52.2%) than non-disabled staff (58.1%) felt that their trust provides equal opportunities for career progression or promotion
more disabled staff (26.6%) said that they have felt pressure from their manager to come to work despite not feeling well enough to perform their duties, compared with 18.5% of non-disabled staff
fewer disabled staff (36.9%) than non-disabled staff (47.8%) were satisfied with the extent to which their organisation values their work

We recommend that these key findings are used to highlight the need for, shape and drive initiatives to support local and system improvements for staff experience and that local data is used to prioritise and evidence progress.

WDES metric 1

Percentage and number of disabled staff in NHS trusts

In March 2024, 5.7% of the workforce across NHS trusts declared on the Electronic Staff Record (ESR) that they have a disability (86,312 people), having increased year-on-year from 3.1% in 2018. Conversely, the percentage of staff who did not declare whether they have a disability or not has decreased year-on-year from 25.4% in 2018 to 14.3% in 2024. Considering those for whom disability status is unknown,* representation of disabled staff in the workforce could be anywhere between 5.7% and 20.0%. Individual trust disability declaration rates range from 2.6% to 16%, showing a large variation in staff declaration rates through ESR.

*Unknown = staff who either did not answer the disability monitoring question or indicated that they prefer not to say on the ESR.

For comparison, 25.05% of respondents to the NHS Staff Survey from NHS trusts indicated that they have a physical or mental health condition or illness lasting or expected to last for 12 months or more, with only 2.2% not answering this question (noting an overall response rate to the survey of 48%).

Reporting on the NHS Staff Survey is more reflective of the UK working-age population, where 24% identified as disabled through the Family Resources Survey: financial year 2022 to 2023.

Percentage and number of disabled staff in NHS trusts – regional breakdowns

The percentage of staff declaring a disability on ESR varied by region. London had the lowest percentage (5.0%) declaring a disability, as well as the lowest percentage (10.7%) of staff whose disability status was unknown. The South East had the highest percentage of staff declaring a disability (6.1%) and the East of England had the highest percentage of staff whose disability status was unknown (18.3%).

Percentage disabled representation at each AfC pay band in NHS trusts

In non-clinical roles, disability representation (that is, the percentage of staff who declared a disability) was 6.7% overall. Representation was highest at AfC band 3 (7.5%) and lowest at AfC band 9 (3.9%), with no consistent pattern in the variation across pay bands.

The percentage of staff declaring a disability in senior non-clinical roles (band 8c to VSM) has increased year-on-year from 2.2% in 2019 to 5.1% in 2024. However, representation in the wider non-clinical workforce has also increased year-on-year at a similar rate, from 3.6% in 2019 to 6.7% in 2024. This demonstrates that the gap between disabled representation at senior levels and in the overall workforce in non-clinical roles has varied little between 2019 to 2024. It is currently -1.6%. The disability status of 14.2% of non-clinical staff was unknown (13.7% at band 8c to VSM level), which adds a degree of uncertainty regarding the levels of representation.

Percentage disabled representation in clinical AfC pay bands outside doctors in NHS trusts

In clinical roles outside medicine, the percentage of staff declaring a disability was 5.8% overall. Representation was highest at AfC band 4 (7.1%) and lowest at AfC band 9 (3.6%) with no consistent pattern in the representation across pay bands. The percentage of staff whose disability status was unknown ranged from 12.3% and 23.1% across the pay bands.

The percentage of staff declaring a disability in senior clinical roles outside medicine (band 8c to VSM) has increased year-on-year from 1.8% in 2019 to 4.2% in 2024. However, disabled representation in the wider clinical workforce has also increased year-on-year at a similar rate, from 3.2% in 2019 to 5.8% in 2024. This demonstrates that the gap between disabled representation at senior levels and in the overall workforce in clinical roles has varied little over the period 2019 to 2024. It is currently -1.6%. The disability status of 13.4% of clinical staff was unknown (14.7% at 8C to VSM level), which adds a degree of uncertainty regarding the levels of representation.

Percentage disabled representation and level of seniority for doctors in NHS trusts

Within medicine, overall 2.4% of staff declared that they have a disability, with representation varying little by level of seniority. The disability status of 21.0% of medical staff was unknown.

WDES metric 2

Relative likelihood of non-disabled applicants being appointed from shortlisting compared to disabled applicants

Relative likelihood ratios comparing the likelihood of non-disabled and disabled candidates being appointed from shortlisting were close to equity (1.0) nationally and in all regions. Specifically, 19.5% of non-disabled candidates were appointed from shortlisting compared 19.8% of disabled candidates. Nationally, only 4 trusts had likelihood ratios that varied to a significant degree from equity (>1.0). Additional work is still needed to ensure equity, factoring in narratives, staff experiences and other relevant considerations.

WDES metric 3

55% of NHS trusts reported that their disabled staff were over 1.25 times more likely than non-disabled staff to enter the formal capability process (2-year rolling average, excluding ill-health related proceedings). Nationally, and in most regions, disabled staff were on average more than twice as likely to enter the formal capability process compared to their non-disabled colleagues, with only the North East and Yorkshire and South East regions below this threshold. Nationally, as a 2-year rolling average, 0.29% of the disabled workforce entered formal capability proceedings compared 0.14% of the non-disabled workforce.

WDES metric 4a

Percentage of disabled staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months

In 2023, at all NHS trusts, a higher proportion of disabled staff than non-disabled staff experienced harassment, bullying or abuse from patients, relatives or the public in the last 12 months. A higher percentage of disabled staff (30.0%) than non-disabled staff (23.3%) had experienced harassment, bullying or abuse by patients, family or the public in 2023, a trend that has been observed in WDES since 2019. However, in the last year, levels of harassment, bullying or abuse dropped to the lowest level since the inception of the WDES, with decreases observed in all regions. Nonetheless, it remains a concern that nearly a quarter of non-disabled staff and nearly a third of disabled staff experience abuse from the public.

Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months by gender, disability and profession

Across all staff, disabled women men were as likely to have experienced harassment, bullying or abuse from patients, their relatives or the public in the last 12 months, a trend that has been observed in WDES since 2019. However, disabled men among nursing assistants (50.8%) and among registered nurses (43.4%) were more likely to experience harassment, bullying or abuse than their female colleagues. Overall, as a profession, ambulance (operational) staff (50.3%) experienced the highest level of incidents, with disabled women (56.2%) and disabled men (56.1%) most affected in this profession.

WDES metric 4b

Percentage of disabled staff experiencing harassment, bullying or abuse from managers in the last 12 months

In 2023, the percentage of staff experiencing harassment, bullying or abuse from managers was higher for disabled staff (14.6%) than for non-disabled staff (8.2%). This pattern has been observed since at least 2019 and was seen in all regions. Although disparities between the experiences of disabled and non-disabled staff persist, levels of harassment, bullying and abuse from managers have followed a downward trend since 2020 and are currently at their lowest since the inception of the WDES.

Percentage of staff experiencing harassment, bullying or abuse from managers in the last 12 months by gender, disability and profession

In 2023, disabled men (16.0%) were most likely to have experienced harassment, bullying or abuse from managers in the last 12 months, a trend that has been observed in WDES since 2019, with levels also high for disabled women (13.2%). This trend was especially observed for disabled men in operational ambulance roles (21.7%). Levels were also high for both disabled women (18.6%) and disabled men (17.9%) in general management.

WDES metric 4c

Percentage of disabled staff experiencing harassment, bullying or abuse from other colleagues in the last 12 months

In the 2023 NHS Staff Survey, the percentage of staff experiencing harassment, bullying or abuse from other colleagues in the last 12 months was higher for disabled staff (23.8%) than for non-disabled staff (15.4%). This pattern has been observed since at least 2019 and was seen in all regions. Although disparities between the experiences of disabled and non-disabled staff persist, levels of harassment, bullying and abuse from other colleagues have followed a downward trend since 2019 and are currently at their lowest since the inception of the WDES.

Percentage of staff experiencing harassment, bullying or abuse from other colleagues in the last 12 months by gender, disability, and profession

In 2023, disabled women (23.0%) and disabled men (22.7%%) were similarly likely to have experienced harassment, bullying or abuse from other colleagues in the last 12 months, a trend that has been observed since 2019. Levels were especially high for disabled men in nursing assistant roles (29.6%) and for disabled women (27.9%) in general management.

WDES metric 4d

Percentage of disabled staff who indicated that they or a colleague reported the last incident of harassment, bullying or abuse experienced at work

In 2023, just over half of staff who had experienced harassment, bullying or abuse at work went on to report the incident, with disabled staff (52.5%) more likely to do so than non-disabled staff (51.4%). This pattern was seen in all regions except London, where non-disabled staff (52.6%) were more likely to report the incident than disabled staff (51.3%). The percentage of those who had experienced harassment, bullying or abuse at work and went on to report the incident has increased year-on-year since 2020.

Percentage of staff who indicated that they or a colleague reported the last incident of harassment, bullying or abuse experienced at work by gender, disability and profession

In 2023, non-disabled men (30.7%) and disabled men (31.4%) in medical and dental roles were least likely to go on to report the last incident of harassment, bullying or abuse experienced at work, followed by non-disabled women (34.2%) and disabled women (34.9%) in medical and dental roles. As a profession, nursing and healthcare assistants (63.1% overall) were most likely to go on to report the last incident of harassment, bullying or abuse experienced at work.

WDES metric 5*

Percentage of disabled staff believing that their trust provides equal opportunities for career progression or promotion

In 2023, across 98.6% of NHS trusts, a lower percentage of disabled staff than non-disabled staff felt that their trust provides equal opportunities for career progression or promotion. Overall, a lower percentage of disabled staff (52.2%) than non-disabled staff (58.1%) felt that their trust provides equal opportunities for career progression or promotion. This pattern has been observed since at least 2019 and is seen in all regions.

* The way that metric 5 is calculated changed from the 2021 NHS Staff Survey onwards and historical figures have been recalculated back to 2019. It was previously calculated by dividing the number of yes replies by the sum of yes and no replies and is now calculated by dividing the number of yes replies by the sum of yes, no and don’t know replies.

Percentage of staff believing that their trust provides equal opportunities for career progression or promotion by gender, disability and profession

Ambulance staff (operational) were least likely to believe that their trust acts fairly with regard to career progression and promotion (48.1%), with especially low levels of belief among disabled men (37.1%) in this profession. Disabled women (46.2%) and disabled men (47.9%) in medical and dental roles also expressed low levels, as did disabled men (48.5%) in the wider healthcare team.

WDES metric 6

Percentage of disabled staff who said that they have felt pressure from their manager to come to work despite not feeling well enough to perform their duties

In 2023, the percentage of staff who said that they have felt pressure from their manager to come to work despite not feeling well enough to perform their duties was higher for disabled staff (26.6%) than for non-disabled staff (18.5%). This pattern has been observed since at least 2019 and was seen in all regions. Although disparities between the experiences of disabled and non-disabled staff persist, levels of presenteeism have followed a downward trend since 2020 and are currently at their lowest seen since the inception of the WDES.

Percentage of staff who said that they have felt pressure from their manager to come to work despite not feeling well enough to perform their duties by gender, disability and profession

In 2023, disabled men and women (26.1% and 25.6%) were most likely to have felt pressure from their manager to come to work despite not feeling well enough to perform their duties. This trend was especially observed for disabled men (39.7%) and disabled women (36.5%) in operational ambulance roles. Levels were also high for both disabled men (28.3%) and disabled women (28.7%) in nursing assistant roles.

WDES metric 7

Percentage of disabled staff saying that they are satisfied with the extent to which their organisation values their work

In 2023, at all NHS trusts, a lower percentage of disabled staff (36.9%) than non-disabled staff (47.8%) were satisfied with the extent to which their organisation values their work. This pattern has been observed since at least 2019 and is seen in all regions.

Percentage of staff saying that they are satisfied with the extent to which their organisation values their work by gender, disability and profession

As a profession, ambulance staff (operational) were least likely to be satisfied with the extent to which their organisation values their work (26.3%); with especially low levels of satisfaction among disabled men (20.3%) and disabled women (23.4%) in this profession.

WDES metric 8

Percentage of disabled staff saying that their employer has made reasonable adjustment(s) to enable them to carry out their work

In 2023, overall, 74.5% of disabled staff reported that their employer had made reasonable adjustment(s) to enable them to carry out their work, which is higher than in 2022 (73.0%). Across the regions, this ranged from 77.1% in the South West to (69.3%) in London.

Percentage of disabled staff saying that their employer has made reasonable adjustment(s) to enable them to carry out their work by gender and profession

By profession, disabled ambulance staff (operational) were least likely to report that their employer had made reasonable adjustment(s) to enable them to carry out their work (63.1%); with especially low levels among disabled men (56.6%) in this profession. Levels were also low for disabled women (69.0%) among ambulance staff (operational) and for disabled men (67.5%) and disabled women (68.9%) in medical and dental roles.

WDES metric 9

Staff engagement scores

The NHS Staff Survey engagement theme is a composite score, standardised to give a value out of 10, with a higher value indicating better performance. It draws from responses to 9 questions across 3 subscales: motivation (I look forward to going to work, I am enthusiastic about my job, time passes quickly when I am working), involvement (there are frequent opportunities for me to show initiative in my role, I am able to make suggestions to improve the work of my team/department, I am able to make improvements happen in my area of work) and advocacy (care of patients/service users is my organisation’s top priority, I would recommend my organisation as a place to work, if a friend or relative needed treatment I would be happy with the standard of care provided by this organisation).

In 2023, the staff engagement score was lower for disabled staff (6.5) than for non-disabled staff (7.0). This pattern has been evident since at least 2019 and is seen in all regions.

Staff engagement scores by gender, disability and profession

Ambulance staff (operational) had the lowest staff engagement score (5.8); with especially low scores among disabled men (5.3) and disabled women (5.7) in this profession.

WDES metric 10

Disability representation among board members

Nationally, in March 2024, 6.5% of board members declared that they have a disability, compared to 5.7% of staff in trusts. In every region except the South West, the percentage declaring a disability on the board was greater than that in the overall workforce. 6.2% of executive board members had declared that they have a disability. It is noted that 17.0% of board members had an unknown disability status.

Disabled representation among all board members compared to the workforce overall

6.5% of board members declared a disability, an increase on the 5.7% in 2023 and 4.6% in 2022. Nationally, the percentage of board members declaring a disability has increased year-on-year. This trend was also observed in all regions except London. At a national level, the percentage of staff in the overall workforce who declared a disability also increased year-on-year, with each region following the national trend.

Disabled representation among non-executive board members compared to the workforce overall

In March 2024, 6.8% of non-executive directors declared a disability, an increase on the 6.0% in 2023 and 5.0% in 2022. The trend in all regions was for the percentage of non-executive board members declaring a disability to increase year-on-year, thus following the national trend.

Disabled representation among executive board members compared to the workforce overall

In March 2024, 6.2% of executive directors declared a disability, an increase on 2023 (5.4%) and 2022 (4.2%). The national trend shows the percentage of executive board members declaring a disability increasing year-on-year, a trend that is seen in all regions except London and the South West.

Conclusion and next steps

There is still more to do to improve the career and work experience of disabled staff, particularly for better development opportunities and reasonable adjustment practices and fewer incidents of harassment, bullying and abuse. An open, compassionate and inclusive culture as set out in the NHS People Promise will support NHS organisations to determine the environment in which disabled staff can flourish, work to the best of their abilities and progress their careers without fear of discrimination and reprisals for speaking up.

We will continue to work with stakeholders, partners and systems at national and regional levels for the benefit of the existing and future workforce. Every voice within the NHS is instrumental in this transformative journey.

Appendix A – Methodology

The WDES requires NHS trusts to self-assess against 10 metrics of workplace experience and career opportunity. 3 metrics relate to workforce data, 6 are based on data from the national NHS Staff Survey questions and 1 considers disabled board representation.

The detailed definition for each metric can be found in the WDES technical guidance. This report presents data against all 10 WDES metrics for all NHS trusts in England and, where possible, makes comparisons to previous WDES data.

Data sources

WDES data for 2023/24 was collected through individual NHS trust submissions via the Data Collection Framework (DCF). A return rate of 100% for trusts was achieved for the numerical data collection with 1 trust not completing the narrative survey.

The narrative survey provides trusts with an opportunity to detail the work they are doing to improve metrics performance with examples featured for some of the metrics as a means of sharing good practice.

Data analyses

For data analyses and presentation, organisations have been grouped by the 7 NHS geographical regions – East of England, London, Midlands, North East and Yorkshire, North West, South East and South West.

For metrics 2 and 3, statistical analyses included the ‘four-fifths’ rule. The ‘four-fifths’ (‘4/5ths’ or ‘80 per cent’) rule is used to highlight whether practices have an adverse impact on an identified group, such as a sub-group by disability, gender or age band. For example, if the relative likelihood of an outcome for one sub-group compared to another is <0.80 or >1.25, then the process would be identified as having an adverse impact.

Data caveats

This report contains data for NHS trusts.

For metric 2, the relative likelihood of non-disabled applicants being appointed from shortlisting compared to disabled applicants is calculated as the percentage of non-disabled applicants appointed from shortlisting divided by the percentage of disabled applicants appointed from shortlisting. This design results in non-disabled applicants being mentioned first in the metric definition and prioritises the detection and tracking of any disadvantage experienced by disabled applicants (values above 1.0 indicate a disadvantage for disabled applicants). The design also provides for a consistent direction of interpretation across metric 2 and metric 3 (that is, that a higher value above 1.0 is less desirable for both metrics).

6 of the WDES metrics (4 to 9) are drawn from questions in the national NHS Staff Survey. The reliability of the data drawn from those indicators depends on the overall size of samples surveyed, the response rates to the survey questions and whether the numbers of disabled respondents are large enough not to undermine confidence in the data.

For the national-level NHS Staff Survey-based WDES metrics that compare disabled and non-disabled respondents, a weighting is applied to each trust’s contribution to the national score. This weighting ensures that each trust’s results have an impact according to the number of staff employed, rather than according to the number of survey respondents. However, for the regional breakdowns and for those looking at disability in more detail alongside factors such as gender, age and profession, unweighted data are used and respondents are pooled across trusts without adjusting for differing trust sizes.

Several trusts have revised their past workforce data, which has resulted in the previous year’s metrics being recalculated, and some NHS trusts may have revised their WDES data returns since their submission via DCF. The results in this report are based on the latest figures returned to NHS England via DCF and will not necessarily incorporate any updates a trust has made to WDES-related publications on organisations’ websites.

The way that metric 5 is calculated changed from the national 2021 NHS Staff Survey and is reported from 2022. Historical figures have been recalculated back to 2019. The change was from dividing the number of yes replies by the sum of yes and no replies to dividing the number of yes replies by the sum of yes, no and don’t know replies.

The NHS Staff Survey question relating to metric 8 was phrased “Has your employer made adequate adjustment(s) to enable you to carry out your work?” in the 2021 NHS Staff Survey, but was changed to “Has your employer made reasonable adjustment(s) to enable you to carry out your work?” in the 2022 NHS Staff Survey; consequently, figures are presented only for the 2022 and 2023 survey years.

Publication reference: PRN01914

Cookies on the NHS England website