What the Reasonable Adjustment Digital Flag is and why this should be implemented

The Reasonable Adjustment Digital Flag is a national record which indicates that reasonable adjustments are required for an individual and optionally includes details of their significant impairments, key adjustments that should be considered, and underlying conditions.

NHS England has built the Reasonable Adjustment Digital Flag in the NHS Spine to enable health and care professionals to record, share and view details of reasonable adjustments across the NHS, wherever the person is treated.

The Equality Act (2010) places a legal duty on all health and care services to make changes to their approach or provision to ensure that services are as accessible to people with disabilities as they are for everyone else. This duty aims to address the recognition that people with disabilities may appear to have equal access to care and services, but without specific adjustments being made, that access may not be equitable.

In September 2023, a Reasonable Adjustment Digital Flag Information Standard was published (under section 250 of the Health and Social Care Act 2012) that details what all NHS and social care organisations in England are required to do about the flag.

This document is a high-level summary of actions required and how to achieve compliance. For more detailed information, please access the Information Standard (and implementation guidance) and the NHS Digital information page.

What organisations need to do

Compliance and implementation of the Reasonable Adjustment Digital Flag Information Standard is by a two-phase approach and organisations should be working towards compliance with phase one by no later than April 2024.

Phase 1: identify, record, flag, share, meet, review reasonable adjustments at local level

Organisations using their own systems and processes to record reasonable adjustment information locally, ie on their own electronic systems and notes ready for sharing via the NHS Spine. Where digital entry is not readily available, organisations should be recording in paper records and subsequently coding digitally either on their own systems or via the National Care Records Service portal.

Phase 2: flag and share reasonable adjustments using the Reasonable Adjustment Flag on the NHS Spine

Please see below for the detail of expectations and timescales for each phase:

This section describes in more detail the actions that teams need to undertake in phases one and two in order to achieve compliance by 31 December 2025.

Phase 1 – What do I need to do?

Action 1 required: identify patients with a disability or significant impairment

Identify people with a disability or impairment as defined under the Equality Act 2010 (a physical or mental impairment that has a substantial and long-term (greater than 12 months) negative effect on ability to do normal daily activities).

How can I do this?

Suggestions on how to achieve this are below (note this is not an exhaustive list):

• Disability and reasonable adjustment section on all new patient forms/registration documents (eg add a standard line “do you require reasonable adjustments?”).
• Disability and reasonable adjustment section on recall, review and appointment letters (eg add a standard line “do you require reasonable adjustments?”).
• Check at first contact.
• Identification during standard health checks such as annual health checks, long-term condition reviews or during programmes such as immunisations (eg annual influenza campaign).
• Opportunistically: at any contact with the organisation.
• Identification through information received in from outside the organisation (such as referral letters, discharge or out-patient letters, community assessments).
• Review of registers or consideration of cohorts coded with conditions which might result in impairment, such as those with conditions resulting in vision or hearing impairment.
• Enable and encourage self-identification and optimise awareness (eg posters, practice website information).

Action 2 required: follow 6 steps process to record on local systems

Organisations using their own systems and processes to record reasonable adjustment information on their own electronic systems and notes, ready for sharing via the NHS Spine in phase 2.

How can I do this?

Suggestions on how to achieve this are below (note this is not an exhaustive list).

Consent

Consent must be obtained to share on the Reasonable Adjustment Digital Flag on the NHS Spine. Ask in the same way as you normally would when you ask if information can be shared and can be considered as “agreement” to share, eg:

“Are you happy for this to be shared with other organisations in the NHS and social care that will be involved in your care.”

In cases where capacity to make decisions (and therefore to agree or decline to share) is not clearly apparent, a capacity assessment may need to be made and/or a best interests decision made.

Phase 2: What do I Need to Do?

Organisations must ensure readiness to share information digitally to and from the digital flag, either via a FIHR® API or via the National Care Records Service.

Organisations must ensure that they and their suppliers have engaged with NHS England by June 2024 to commence the onboarding process for integration and have established a process to upload and download reasonable adjustment information to and from the national Reasonable Adjustment Digital Flag.

More information on these aspects can be found within the information standard documents and the NHS Digital website page.

Summary: checklist of actions

• Develop a policy which is in line with the Reasonable Adjustment Digital Flag Standard and amend any other impacted policies.
• Agree a comprehensive approach to identifying disabled people with reasonable adjustment requirements including the new patient process in line with the Reasonable Adjustment Digital Flag Standard.
• Establish a clear process for recording individuals’ disability and reasonable adjustment information in line with the Reasonable Adjustment Digital Flag Standard.
• Create and establish a Reasonable Adjustment Flag in local patient record systems, in line with the standard, to highlight and make individuals’ disability and reasonable adjustment information highly visible to staff.
• Establish a clear process for sharing individual’s disability and reasonable adjustment information in line with the Reasonable Adjustment Digital Flag Standard
• Establish a clear process for reviewing and updating information on the individual’s records relating to disability and reasonable adjustment information in line with the Reasonable Adjustment Digital Flag Standard
• Ensure organisational readiness for future digital integrations.
• Provide training and briefings to staff to explain the Reasonable Adjustment Digital Flag Standard, detail processes to be followed and raise awareness of support which staff can provide themselves. National training for frontline staff via a short e-learning module will be rolled out in April 2024.

Resources

You can find examples of how organisations are achieving compliance and resources to support your organisation to do the same, including examples of each of the 6 step process on the NHS Futures platform (if you do not have currently have access, you can request this by clicking on the link and requesting an account).

The information standard and implementation guidance is available on NHS Digital’s website.

Further information about the Reasonable Adjustment Digital Flag is also available on NHS Digital’s website.