Making decisions about disabled students and their fitness to practise

1
Making decisions about disabled students and
their fitness to practise

• Jane Wray, Research Fellow,
• Faculty of Health and Social Care
• 17th December 2007

2
Context of research

• Disability Legislation (DDA1995/2005)) including
  SENDA (2001) and DRC Codes of Practice (2004)
• Trade organisations and Qualifications Bodies
• Employment and Occupation
• Disability Equality Duty (2006)
• Professions attempting to meet obligations under
  legislation within a context of public protection
  and Health and Fitness standards

3
Aim

• The overall aim of the project was to examine
  formal and informal decision making
• Fitness Standards formal regulations and the
  operation of policies, practices and procedures
  for making decisions about a persons ability to
  enter, qualify and work in the professions
• Decisions about fitness are made at various
  stages in a persons career and generally require
  people to declare a health condition or
  disability that might affect their training or
  work

4
Method

• A two-part survey was used
• A questionnaire section (quantitative) and
• A case study section (qualitative)
• This was developed by the project team in
  conjunction with the Advisory Group and DRC
  Steering Group
• Ethics Committee Approval from FHSC in September
  2006
• Data analysed using SPSS v14 and NVivo v7.

5
Sampling and Response rates

• 20 random sample (England) and 100 sample
  (Scotland and Wales)
• 100 Surveys distributed and 39 returned 39
  response rate
• Nursing 37 response rate
• Teaching 44 response rate
• Social Work 33 response rate
• 12 of education providers formally declined to
  participate

6
Key findings

• Policy
• Guidance
• Format and stage of declaration
• Fitness Panel
• People involved in decision making

7
Policy
8
Guidance documents
9
Comments onGuidance documents

• guidance from the professional body was
  limited other professional groups such as health
  professions /veterinary medicine appeared to have
  considered the issues of clinical practice with
  greater enlightenment. (Nursing, Disability
  staff, England)
• Able to Teach Whilst this was useful, the most
  relevant case was ambiguous however, as the Dean
  of Faculty said just because it has not been
  done, does not mean it cannot be successful.
  (Teaching, Disability staff, England)

10
Format of Declaration
11
Stage of Declaration
12
People involved in decision making
13
Involving the disabled applicant

• Overall 68 involved the disabled applicant in
  decision making
• This was highest in nursing (90) however only
  50 of the case studies from nursing reported
  involving the disabled student Needs were
  identified by reviewing the skills to be achieved
  and assessing how the students disability
  affected the performance of the skill. The
  student was actively involved in this assessment
  process. The student also identified concerns
  and fears relating to clinical practice.
  (Nursing, Disability staff, England)
• This was lowest in Teaching (37) of cases
  however this was reported as 63 in the case
  studies

14
Involvement of Occupational Health

• 100 of Nursing education providers involved OH
  in the decision making process. This was lower in
  Teaching (67) and Social Work (56).
• Good health will normally be checked through a
  health questionnaire completed by a local OH
  department. Where an applicant declares an
  illness, the OH department doctor either
  undertakes a medical examination or seeks further
  information from the applicants GP, or possibly
  both. Once the OH assessment has been done, the
  programme providers are advised as to the fitness
  of the applicant to undertake the programme.
  (NMC 2004 pg 2)

15
Fitness/assessment panels

• Less than half (40) of the nurse education
  provider institutions had a formal committee or
  assessment panel compared to 33 Teaching
  institutions and 50 Social Work Institutions
• 33 of Nurse education providers involved their
  regulatory body in decisions made by their
  Fitness Panel/Assessment Panel compared to 7 of
  Teaching and 71 of Social Work respondents

16
Concerns

• initial concerns related to capability for
  moving and handling of patients, reacting quickly
  to emergency situations including running after a
  patient who absconds from the ward, level of
  stamina for shift work, including 12 hour
  shifts. (Nursing, Scotland)

• Concerns about stamina in completing school
  practice, absence from lectures and school.
  (Teaching, Wales)
• The student was concerned about whether she
  would have any difficulty at the time of an OH
  Check and registration with regulatory body.
  (Social Work, Eng)

17
Maintaining StandardsPromoting Equality

• The report recommends the revocation of the
  legislation, regulations and statutory guidance
  laying down requirements for good health or
  fitness of professionals. There are two reasons
  for this the negative impact on disabled people
  and our conclusion that they offer no protection
  whatsoever to the public. (p3)
• It also argues that "the use of generalised
  health standards, while not solely responsible
  for the automatic assumption of risk in relation
  to disabled people in the professions, provide a
  statutory basis for these negative attitudes. (p
  219)

18
48 recommendations of which 7 are directed at HE
institutions

• (1) Not prejudge the professional competencies
  of disabled applicants/students.
• (2) Consider research carried out, and advice
  given, by HE institutions around supporting
  nursing students with dyslexia. Sufficient
  information about adjustments should be shared
  with work placement providers, with the students
  permission.
• (3) Properly plan work placements for disabled
  students

19
HE institutions should

• (4) Ensure OH are enabling and do not focus on
  medical diagnosis
• (5) Ensure disabled people are not expected to
  meet competence standards at times that other
  students are not
• (6) Carry out impact assessments of work
  placements, OH services and admissions procedures
• (7) Monitor disabled students and use this
  information to inform impact assessments and
  action

20
In conclusion

• "There are real difficulties in marrying up
  two approaches- on the one hand the positive
  encouragement of disabled students into HE and on
  the other the regulatory frameworks that require
  compulsory disclosure and often lead to
  discriminatory policies and practices. (pp 170 -
  171)

21
For further information, please contactJane
Wray, j.wray_at_hull.ac.uk,44 (0) 1482 464606The
full report and further information about the
DRCs Formal Investigation can be accessed
at www.maintainingstandards.org