Increasing the representation of the disabled community on trust boards is being hindered by a lack of understanding and guidance, writes Daloni Carlisle

In last week’s issue, HSJ looked at how NHS organisations have now met government targets on increasing the black and minority ethnic representation on their boards and now need to move beyond the tick box to get the full benefits. This feature focuses on an area where the NHS is having less success: disability.

Disabled people have some of the best insight into some of the really critical issues we are going to be facing in future and we need them on board

Currently, less than 5 per cent of non-executive members of NHS trust boards have declared themselves as disabled, against a target of 14 per cent by 2011.

“We have a long way to go on disability,” admits Andrea Sutcliffe, chief executive of the Appointments Commission, the body that oversees the appointment of non-executives. Its scope does not extend to foundation trusts, although one quarter of them have now asked the Appointments Commission to support them in appointing board members.

Liz Sayce, chief executive of the disability charity Radar, feels that this is a fundamental issue for the NHS. “First, there is the question of fairness,” she says. “Then there is the direct experience of using health and social care services that disabled people have had. They really have something to offer.”

However, there are a number of barriers to people with disabilities taking up non-executive jobs.

The first is the definition of disabled that is enshrined in the Disability Discrimination Act 2005 as “someone who has a physical or mental impairment that has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities”.

This covers an enormous range of disabilities, including living with long term conditions such as diabetes or HIV/AIDS.

On the one hand, there are people who do not even realise that, under this definition, they are disabled.

Sutcliffe says: “An awful lot of people who are included in this definition do not think of themselves as disabled and would never in a month of Sundays declare themselves as such, even in an anonymous monitoring form.”

On the other hand, it includes people with mental health problems and learning disabilities. “This is an issue that we struggle with,” says Sutcliffe. Even making an interview process fair is a challenge.

Then there are benefits issues. Non-executive director jobs are paid and are effectively closed to some disabled people, who would lose their benefits.

Liz Sayce, chief executive of the disability charity Radar, identifies another: the competencies required of non-executives that can exclude those who have not had a full-time, high-flying career. She says: “There are some very bright, very talented disabled people with lots of relevant experience who have not had a standard career.”

Recently, Radar and the Appointments Commission have started working together to make sure disabled people not only know about up and coming non-executive jobs but are well placed to compete for them.

This guidance is in much demand. In February 2010, for example, they ran a joint workshop. Originally intended for 20 people, it attracted 40. Radar now runs a course on leadership development that will help people who have followed non-standard career paths.

None of this is easy to solve but that does not mean PCTs and trusts should not try.

As Ms Sutcliffe says: “Disabled people have some of the best insight into some of the really critical issues we are going to be facing in future and we need them on board.”

Case study: Swindon PCT

Michelle Howard was 16 when she went for a routine jaw operation. She woke up paralysed from the waist down. Now 43, she is a wheelchair user and chair of Swindon PCT.

She brings to the job her vast experience of using health and social care as well as skills from her background as a solicitor, specialising in medical negligence cases.

She says: “My experience ranges from some of the best to some of the not so good and that is the driving force for my being involved in the NHS now.”

She joined the PCT as a non-executive in 1997 and has served as chair since 2004. She was recently appointed a “public appointments ambassador” by the Cabinet Office, a role that will see her promoting public appointments to disabled people generally.

She says: “Part of the chair’s role is about going out to communities and hard to reach communities. Because I am a user of services and a wheelchair user, people identify with me quite readily.”

Disability issues

  • Disabled people have more fear of crime, are more likely to be unemployed, less likely to reach the top of their profession, are less satisfied with their housing and social care, and less likely to take part in sport and in civic life.
  • 32.3 per cent of disabled people took part in sport in 2008 compared with 59.6 per cent of non-disabled people
  • One in 100 disabled people are involved in civic life (eg becoming a councillor, NHS non-executive, school governor) compared with one in 50 non-disabled people

Make the change

What can trusts and PCTs do?

  • Work with Radar, the Appointments Commission and other local disability groups to seek out potential disabled candidates for jobs. Contact:
  • Make sure meetings are held in accessible venues
  • Think carefully about how papers are presented - a written paper available for the first time at a board meeting will not be useful to a sight impaired non-executive