Embracing difference this Disability History Month

Physiotherapy staff are recognising diversity in all its shapes and forms as a vital way of bringing new perspectives to healthcare – a spark to drive improvements in quality of care and patient outcomes.

A growing sense of identity and empowerment has partly driven a 51 per cent increase in CSP DisAbility network membership over the past three years. However, some still join because disablism is all too often closing off courses, opportunities and careers, and making every day a struggle. 

Examples abound of delayed reasonable adjustments, deprioritised or deemed incompatible with everything from the IT set-up to the pace of work. For those fighting through this, finding you are not alone is a lifeline. 

DisAbility’s 500-plus members are standing together with healthcare allies to celebrate the strengths they bring to the workplace this Disability History Month (which runs from 16 November – 16 December).

Among them will be the one in five of us with a difference in brain function. This includes those who are autistic, dyslexic, dyspraxic, have ADHD or another form of neurodiversity. 

To mark the month, we spoke to four neurodiverse physiotherapists who gave their take on navigating the profession when ‘your brain works differently’ and offered valuable insights about what you can do to help colleagues with impairments to maximise their potential. 

Graeme Watson, director of Kilmalcolm Physiotherapy

Graeme was diagnosed with dyslexia aged 17 and runs Kilmalcolm Physiotherapy with his wife Nicola after leaving the NHS at a senior grade.

‘My wife has been my rock throughout the struggles I’ve had navigating the difficulties related to the lack of reasonable adjustments and support throughout my NHS career,’ he says.

As a dyslexic person who worked at a band 8A clinical role, he battled in vain for years for reasonable support from the NHS.

During this time, he undertook five Access to Work (ATW) claims across three jobs in two different health boards in an attempt to facilitate this.

Having been well supported with his dyslexia at school and during his master’s, he knew what good looked like when it came to inclusion and still feels let down by successive NHS managers, HR and occupational health. 

‘There was a cascade of issues, as they didn’t understand what a disability is, and therefore where their responsibilities lay, which led to IT acting as a blocker.’

At one point he was told time management and dyslexia strategy training could not be supported as they were CPD.

This was particularly galling as his dyslexia adds to his deep knowledge working as an advanced practitioner. 

‘I love the dyslexia ability, because it allows me to logically assess very complicated things, which you do all the time as a physiotherapist,’ he says.

‘For example, a lot of physiotherapists find the hand scary because there are lots of three letter abbreviations. Whereas I go, “well, it’s actually 57 individual things, so that makes 57 easy things as opposed to one complicated thing.” It’s about complex clinical presentation and expert clinical reasoning.’

Graeme was open about his dyslexia when applying for jobs in a bid to find a fully supportive workplace. ‘However, absolutely nobody from management to occupational health or interview panels ever asked me anything about my dyslexia.’

Review reasonable adjustments on an annual basis or whenever your job changes

The lack of support felt a struggle. Then, years into the job, he failed a notes audit. 'A new manager had been put in place in a job I had been at for a few years and she told me, ‘Your handwriting's dreadful, it’s not acceptable.’ And I thought, ‘Oh my God, I've been found out, I’m going to get sacked.’ But then she said, ‘How can we help you with it?’

She supported him through an Access To Work assessment, after which he was given dyslexia specific training, and IT to help him produce typed notes. However, he wasn’t given any time management support, or specific coping strategies.

‘I felt at that point grateful to be given anything,’ he says. ‘However, I now realise it is my legal entitlement to be offered all adjustments deemed to be reasonable by both parties. If that had happened and it had carried through into my next two senior roles, I may well have still been employed in the NHS today.'

The Equality Act 2010 may place a failure to provide reasonable adjustments in the realm of disability discrimination. But getting them remains problematic.

By the time he was a Band 8A at another health board within NHS Scotland, the cumulative effect of battling to get reasonable adjustments while struggling with 'workarounds' he calls 'incompetent' made the job impossible. After some time off work with anxiety caused by the 'mental battering' Graeme endured, he came back to the role.

'In my return to work interview I felt completely unsupported and terminated it' He saw the AHP manager on the CSP’s advice. 'She told me, "You do understand that dyslexia has nothing to do with bad handwriting Graeme". That was when I really burned out and hit rock bottom.'

Looking back, he wishes he’d known about the CSP’s DisAbility network much earlier. Through it, he’s gained access to medical, legal, employment and practical knowledge from the network – together with a feeling he is no longer alone. 'It would have been great to have their support, but I had to lean on family - most importantly, my wife Nicola,' he adds.

Graeme eventually quit the NHS to work full time at the private practice he’d previously set up. 

‘I was able to fully implement an ATW process into my private practice within weeks - demonstrating that it can be done very easily.’

He discovered the CSP’s DisAbility Network after leaving the NHS. Through it, he’s gained access to medical, legal, employment and practical knowledge from the network – together with a feeling he is no longer alone. Now a DisAbility committee member, he has advice for others who find themselves in his situation. 

‘Even if you have an Adjustment Passport to take to a new job, ask for another reasonable assessment.

‘And if the IT is delayed, continue to have new assessments so you can have things like extra time or a reduced caseload until it arrives. Review reasonable adjustments on an annual basis or whenever your job changes.’

Laura Bunce, band 5 rotational physiotherapist at Oxford University Hospitals NHS Trust

A late diagnosis in adulthood can be a positive experience, helping people to make sense of themselves, as Laura found out. ‘I’ve always just noticed a slight difference in the way I think and approach things – coupled with really keen interests in different topic areas that I’m passionate about,’ says Laura.

Known to many from her “studygram” @lauraphysiostudies,which she launched during her physio MSc course at the University of Southampton, Laura received an overwhelmingly positive response when she recently revealed her attention deficit hyperactivity disorder (ADHD) diagnosis, aged 25.

Having researched the unique way her brain works, and matched traits to ADHD, it came as a relief rather than a shock. Despite the diagnosis coming in the middle of her band 5 rotations, she says it ‘was helpful to have something to be able to explain the way in which I do things, see the world and communicate with people in order to ask for support’. 

Her mixed type ADHD (inattentive and hyperactive) means she sometimes struggles to direct her focus and attention, or retain information. She describes her thoughts as always going at ‘3,000 miles an hour’, making it hard to switch off.

Laura dubs it a superpower and cites examples of the positives it has in her life, including at work.

‘I’m very creative in my rehab options for patients as I know how difficult it can be to engage in something which is boring.

‘As I like to see a bigger, more holistic picture I’ll tailor treatment approaches to their interests. I enjoy being involved with lots of different projects at work – trying new clinical specialities on rotation or my new research internship. Physio is a great profession for that.’

After a ‘really good conversation that opened my eyes’ with her OH nurse and then line manager, they co-created a package of reasonable adjustments including having a work laptop and time and space to write notes away from the team, if required.

Laura has also applied for the government funded ATW scheme and is hoping to receive funding for a coach – ‘somebody to help me suggest other coping strategies or things I haven’t yet thought of, to help.’

‘That’s my top tip for managers or colleagues,’ she continues. ‘With the person’s permission, ask what they need to feel supported in the best way for them. Don’t chuck ideas at them in an attempt to help, as they have likely already tried those things. The conversation needs to be supportive and person-centred, so they feel comfortable enough to say, “this is what I need.”’

While acknowledging this conversation can be intimidating for a physiotherapist to initiate, she found it stress relieving, and validating.

Neurodiversity should never be seen as a negative thing or something which should hold you back

‘I was anxious about it, but if you admit you’re struggling with something, it enables you to put something in place to help you to make life easier for yourself, which helps you work in a more effective way for your own brain and ultimately reduces stress. Explaining how my ADHD impacts me day-to-day to my line manager was empowering. It helps those around me to understand me better.’

Though her workplace experience was entirely positive, she’s no stranger to microaggressions outside the NHS. More thought about the language we use around impairments will increase along with awareness, she hopes.

‘People should not joke “oh, I’m a little bit ADHD today” when they feel fidgety or more forgetful. Thinking about language and inclusivity is so important because microaggressions, regardless of the context, are really very impactful for a lot of people.’

Iona Bateman, vice chair of the CSP DisAbility network 

If ever a person exemplified the ability to multi-task with passion and laser-like focus, it’s Iona. She was nominated in eight out of nine categories of the University of Southampton’s recent student experience awards for her many superlative projects. She puts this down to her ADHD.

‘When I won this overall award for basically being nominated for everything, the nomination read like an ADHD diagnosis,’ she jokes. ‘But ADHD is my superpower – it gives me the ability to do so many things at once. As a physio, when you’re seeing up to 10 patients a day, you’ve got to turn them around fast. That hasn’t been an issue for me.’

She started her physio journey with chronic scapho-lunate dissociation in her right, dominant hand She was subjected to severe discrimination from some universities during the admissions process, which served to awaken her activism.

Since opening up about this in Frontline Disabled, not defeated, she has received dozens of messages from students hiding impairments for fear of expulsion.

‘They’ve since disclosed and received support from their university and by joining the CSP DisAbility network. It’s incredible feedback and has made my own negative experience completely worth it,’ she says.

But a relatively recent diagnosis of ADHD meant she, too, needed the network’s support. ‘It’s only by speaking to others with ADHD in the network, and my coaches at university, that I’ve realised a lot of people understand the things I was desperately trying to mask and overcome my whole life,’ Iona explains.

‘It’s not me being stupid or lazy, and it’s not a mental block, it’s just that my brain functions differently. Now they can give me tips on how to make the most of my abilities.’

She is very clear that neurodivergent people need support based on their specific strengths and challenges.

‘When people contact me concerned that they have a new student with a disability, asking how to support them, the first thing I say is, “well, have you asked them?”’

To help managers and those with impairments navigate reasonable adjustments, the CSP DisAbility network has been running sessions with the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) to explain the options. You can access them here at ACPOHE.

ADHD is my superpower – it gives me the ability to do so many things at once

But as you might expect, Iona’s plans don’t stop there. ‘Setting up an IT account and getting assistive software is a big problem for a lot of students on placement, so we are discussing whether students with a disability can stay in one trust, with one IT account, for the duration of their degree.

‘I also want to create a mentorship scheme for disabled students, connecting them with a practitioner with a similar disability as a point of contact and motivation to keep going during placement when attrition rates are at their highest.’

Meanwhile, her next goal is a university project on how AI could help those with neurodiversity get past the “blank page” barrier at the start of a project.

‘It’s my passion to reduce the barriers for under-represented groups that gives me the energy and resilience to keep pushing for a thriving and equitable future for all members of our profession.’

Jasmine Churms, band 5 rotational paediatric physiotherapist at Bristol Children’s Hospital 

Jasmine describes herself as a queer, autistic woman fighting for change. For the CSP DisAbility committee member, her autism is a key tool in helping her win that fight.

Not only does it allow her to juggle multiple projects, and tailor sessions for the neurodiverse, it gives her a relentless drive for service improvement.

‘It’s a trait for autistic people that we get very passionate when we do find something we love and our approach is, “OK, what can I do to improve it? What can I do to learn?”

‘Knowing I’m making a difference and helping people by bringing things to the table that others may not think about, especially when it is disability related, makes me passionate to keep going.’

Higher rates of attrition among physiotherapists with impairments remains a problem, according to DisAbility. And Jasmine, who was diagnosed as a teenager, acknowledges that her autism can be challenging.

‘Autism is like a buffet of different traits, and on my plate is information processing – it takes me longer to process and learn new information – and sensory processing. I’m very sensitive to some kinds of sounds, smells and sights, so fatigue is my biggest thing.’

She finds change difficult, including starting new rotations. Preparation is key – a lesson for both herself and managers. ‘They need to be able to support you before you start to ease the change, so I always ask, “can you invite me to shadow and learn before the rotation?” And I’d like to see managers being proactive in researching about the disability of the person they are going to support.’

For Jasmine, reasonable adjustments have been the difference between thriving and questioning your choice of career.

‘When I first started work, I almost had to struggle to survive. But with reasonable adjustments, I could work in a way that suited me best. I felt I was being successful, and that gives you the ability to help and encourage others, whether that’s patients or others in your position.’

She sees the Adjustment (sometimes called Disability) Passport as key to starting difficult conversations from scratch and avoiding renegotiating what’s already been agreed. It can pave the way for an honest and safe discussion with a line manager about what a physiotherapist needs to work effectively. 

There is a space on the Common Placement Assessment Form for this too, which can help students outline their needs in the same way.

Having someone to support you, ready to listen, and kind of put aside any assumptions they have, is key, so they have their expertise on the service, and you have your expertise on your ability and the condition

While Jasmine had supportive line managers, microaggressions from others have knocked her confidence occasionally.

‘It’s mainly from people thinking that because of how I present that I’m not affected by my disability – so I don’t need help with this or that and should just be able to do it. It really makes me doubt my ability and brings out that internal ableism, which is really hard to deal with.’

Fortunately, she has found support through DisAbility, where others share similar experiences, and a wealth of knowledge to support one another.

Now, when thinking back to all the times she was asked whether acute medicine was the right choice for her, her answer comes with fierce conviction.

‘I’m in a career that I absolutely love, and want to continue doing for a long, long time and there shouldn’t be a limit on me because of how my brain processes things.’