Regulations for considering reasonable adjustments in practice for CNMH students on courses leading to registration

1. Purpose of the regulations

1.1 The University aims to support students with disabilities or other short-term and temporary health concerns to meet the objectives of their courses and the professional competencies required.  

1.2 The purpose of these Reasonable Adjustments in Practice Regulations is to ensure that students with disabilities in practice placements are provided with reasonable adjustments to prevent them from being substantially disadvantaged as a result of their specific disabilities and/or to mitigate risk to safe and effective practice.  The Regulations are also to ensure that students with disabilities and students with other short-term physical or mental health conditions are: 

• Able to meet the competence standards set by the relevant professional body 

• Able to uphold the professional standards as set by the relevant code of conduct 

• Able to protect the public.   

• Able to safeguard vulnerable adults and children.  

2. Scope

2.1 These Regulations apply to those students undertaking Professional Courses which: 

• a) lead to professional registration;  
• b) are governed by professional bodies including the Nursing and Midwifery Council, the Healthcare Professions Council and Social Work England; or  
• c) courses involving working with children or in a care setting with vulnerable adults; and  
• d) include practice placements as an integral part of the course. 

2.2 The Professional Courses include, but are not restricted to, pre-registration courses in nursing, midwifery, social work, paramedic medicine and operating department practice. These Professional Courses are subject to the requirements and standards of their respective professional body.  

3. Principles

3.1 Competencies – all students must meet the competencies required by the professional body in order to pass the course.  Any reasonable adjustments will be made with a view to enabling the student to meet these and to be able to operate safely and effectively in practice.   

3.2 Full time working on placements – the College of Nursing, Midwifery and Healthcare policies for Practice Placement learning state that healthcare students must work the shifts of the wards or trusts, and work a variety of shifts including days, afternoons, nights, and weekends as required. 

3.3 Reasonable Adjustment Placement Passport – this document is developed by the Wellbeing Team (together with the Reasonable Adjustments in Practice Panel in some instances) to provide information for the Practice Placement on the reasonable adjustments recommended for the student whilst out on placement.  This is different from the Individual Support Plan (ISP) which is developed to provide reasonable adjustments for academic studies and assessment. 

3.4 Determining reasonable adjustments in practice - the Reasonable Adjustment Placement Passport is a set of reasonable adjustment recommendations for the Practice Placement to consider and implement. The Practice Placement will ultimately determine if they are able to support the reasonable adjustments. There may be differences between Practice Placements as to whether the recommendations can be implemented due to the nature of different placement environments.  

4. The University’s legal responsibilities

4.1 Under the Equality Act 2010, the University has a duty to ensure students with disabilities are not disadvantaged in accessing learning and assessment. The University’s duty is, therefore, to make reasonable adjustments to the way its courses are taught and assessed. Any reasonable adjustments in support of learning and assessment will be set out in the Individual Support Plan (ISP).  

4.2 In addition, a Placement Provider has a separate duty to provide reasonable adjustments for students undertaking placements within their practice area where their specific disability puts them at a substantial disadvantage in that environment. However, reasonable adjustments cannot be made to a competence standard. Adjustments must be made in order to help the student meet the standard where these are reasonable.  Any reasonable adjustments will be recommended to the Practice Placement through a Reasonable Adjustment Placement Passport.     

4.3 Whilst it is the student’s responsibility to disclose a disability or other health issue as appropriate, the University is ultimately responsible for making the Placement Provider aware of the requirements of the placement student, and the need to make reasonable adjustments, where such disclosure has been made to the University by the student. 

4.4 Where students have not made arrangements with Wellbeing or disclosed a disability or other health issue, the University also has a duty to act if is clear to staff engaging with the students that they have a disability or health issue that may impede patient or client safety.  In these circumstances, students will be required to attend an Occupational Health appointment before being able to attend in practice. 

5. Student’s responsibilities: Medical fitness for health courses 

5.1 Students applying for a course leading to professional registration in one of the health care professions should be medically fit to enrol on the course and to be able continue with their studies if there is a change in their health during the course.  

5.2 Students must also be aware of the importance of their own health and the effect that their health has on their ability to practise the relevant profession safely and effectively.  

5.3 The University seeks advice from its contracted Occupational Health services regarding students’ medical fitness to study. Applicants to these courses are, therefore, required to disclose health conditions for Occupational Health screening, and have a continuous duty to disclose any health conditions which emerge subsequently for medical fitness purposes.   

5.4 Medical fitness is determined by the physical and psychological functioning of the student balanced with the functional requirements and competences of the course, taking into account potential risks to the student, patients under their care and others.  In the determination of medical fitness, reasonable adjustments may be recommended by Occupational Health to support the student to meet medical fitness in practice. Students have a duty to disclose such reasonable adjustments to the University where without the implementation of those adjustments, the student would not be medically fit to engage in the practice placement activities.  

5.5 Medical fitness encompasses a wide range of criteria including evidence of immunity, mobility, upper limb function, vision, hearing, speech, literacy and numeracy, skin function, interruption of consciousness, concentration, awareness, memory and the ability to learn and understand. 

5.6 Students may be referred to a Fitness to Practise Panel if they: 

1. fail to disclose information on application which would have an adverse impact on their medical fitness to study and on their ability to undertake the practice learning safely or effectively;   

2. have an undeclared physical or mental health condition which affects their performance and may, therefore, put themselves or others at risk;   

3. do not declare any subsequent issues which may have a negative impact on their medical fitness to study and/or ability to undertake the practice learning safely or effectively.  

6. Students’ responsibilities: Disclosure for the purposes of reasonable adjustments  

6.1 Students on Professional Courses have a duty of care to patients/service users/carers under their care to provide care and support to a proper standard and a duty to ensure that they can practise safely and effectively. This means that applicants and students should disclose and seek advice and support regarding a disability or a short-term mental or physical illness that negatively impacts or may negatively impact on their learning and ability to engage safely or effectively in the practice area for the purposes of ensuring reasonable adjustments are put in place.  If an applicant or student is unsure whether, the should seek advice about disclosure from the Wellbeing Team and/or the Course Leader. They are encouraged to do this prior to admission where possible so that any assessment of reasonable adjustments can be made as soon as possible and that any decision that an applicant or student will not be suitable for the course can be made in a timely manner. 

6.2 In circumstances where their disability or a short-term mental or physical illness does not pose a risk as outlined paragraph 5.1 above students are nonetheless encouraged to disclose disabilities to the University.  This is to ensure that that they can benefit from the support of reasonable adjustments (if these are required) for their academic work or in the practice placement.  Students are encouraged to do this as soon as possible so that they can benefit from this support.   

6.3 For academic study at the University, reasonable adjustments will be made through an Individual Support Plan.  In the practice setting, however, not all the adjustments made to support academic study may be reasonable.  Different adjustments may be required to support the learning in the practice setting where these are reasonable. Reasonable adjustments appropriate for the Practice Placement will be set out in the Reasonable Adjustment Placement Passport. It is the student’s responsibility to work with the Wellbeing Team to complete the Reasonable Adjustment Placement Passport and to disclose these requirements to the practice area unless their disability does not affect their ability to practise safely and effectively.  

6.4 Where a student is referred to Occupational Health for medical fitness assessment before going into practice, it is the student’s responsibility to share the Occupational Health report and recommendations with the Wellbeing Team and where necessary the Reasonable Adjustments Panel.  If the Occupational Health report is not shared with the University, it cannot put in place any reasonable adjustments.  

6.5 Where a student’s disability or other short-term or temporary physical or mental health condition could impact on student and/or patient or client safety, they have a duty to disclose this to the University and the practice placement., Where safe and effective practice are not at risk, it is the student’s choice whether they share information regarding their illness or disability and/or related reasonable adjustments with the University and the Placement Provider. In the absence of any such risk, students may choose to disclose the reasonable adjustments required in respect of their disability to Placement Provider without disclosing information relating to their specific disability.  

6.6 Where a student does not wish to share details of their reasonable adjustments with the Placement Provider, it is their responsibility to explicitly inform the University of their wish for confidentiality. Otherwise, where confidentiality is not expressly requested, the University has a responsibility to ensure that any declared reasonable adjustments for disabilities and other physical and mental health conditions are shared with the Placement Provider to ensure that those adjustments are implemented while the student is engaged in practical placement activities.   

6.7 Students should note that in circumstances where the University considers that the reasonable adjustments are required for student and/or patient or client safety, such confidentiality may not be appropriate.  Where there is a risk to safety of patients, services users or others in the practice placement and Placement Provider needs to know about the specific reasonable adjustments in order to mitigate those risks.  The consequence may be that the student is not allowed to undertake the placement and the matter may be referred under the Fitness to Practise process for further consideration 

7. The role of occupational health  

7.1 The role of Occupational Health is an advisory role to the University.  It is ultimately for the University to decide, having received information from Occupational Health and other relevant sources, whether the proposed adjustments are reasonable and whether the applicant / student has the capability to safely perform to the appropriate professional standards, with reasonable adjustments, without supervision on joining the register. 

7.2 Similarly, although reasonable adjustments may be recommended by Occupational Health and assessed as reasonable by the University, it is up to the practice placement to determine whether these can be accommodated in the practice area.   

8. Reasonable adjustment and the placement passport procedure 

8.1 Prior to undertaking a placement, in instances where a student has disclosed their disability and/or requirements for reasonable adjustments to the University, the University’ Wellbeing Team will determine what reasonable adjustments are appropriate in support of the student’s placement and create a Reasonable Adjustment Placement Passport, subject to the input of the Reasonable Adjustments in Practice Panel, as set out in paragraph 8 below if required.  

8.2 Depending on the complexity of the disability or other short term or temporary health issue, some students may require an occupational health appointment before approaching the Wellbeing Team to complete the Reasonable Adjustment Placement Passport. 

8.3 Where required, students will be referred by their course leader for an occupational health appointment. Following their occupational health appointment, Occupational Health will provide a letter to the student with a summary of the appointment and a list of recommendations for reasonable adjustments (Occupational Health Report). 

8.4 Where the Wellbeing Team and/or the course leader does not consider that the Occupational Health recommendations, or other recommendations from other professionals are appropriate, this will be referred to the Reasonable Adjustments in Practice Panel to make a determination in accordance with its remit as set out in paragraph 8.2 below.  This may also be the case if the student is requesting particular adjustments in practice that may not be reasonable.   

9. The role, remit and membership of the Reasonable Adjustments in Practice Panel 

9.1 The role of the Reasonable Adjustments in Practice Panel is to consider cases where; 

• a) the potential reasonable adjustments required are beyond the standard  
• b) reasonable adjustments ordinarily processed by the Wellbeing Team; the Wellbeing Team require support and assistance in assessing reasonable adjustments for recommendation in the Reasonable Adjustment Placement Passport; 
• c) The adjustment considerations require the input of an expert  practitioner in the profession/practice area the student will be undertaking a practice placement to assess what would be reasonable in the circumstances; or 
• d) A Practice Placement has reported they cannot accommodate the reasonable adjustments recommended in the Reasonable Adjustment Placement Passport. 

9.2 The remit of the Reasonable Adjustments Panel is to:  

• a) To determine reasonable adjustments or other actions for recommendation in the Reasonable Adjustment Placement Passport that enable the student to gain the appropriate competencies in the Practice Placement to pass the course and to be assessed as fit to practise. 
• b) To refer the matter to a Fitness to Practice panel where it is not possible for the Practice Placement to accommodate reasonable adjustments, such as withdrawal or deferral from the course. 

9.3 In undertaking its work, the Panel will consider the Equality Act (2010) and the University provision for reasonable adjustments together with the professional body requirements. 

9.4 Membership of the Reasonable Adjustment in Practice Panel will be as follows 

• a) The Chair who will be a Senior Academic from the School of Nursing, Midwifery and Healthcare 

• b) One member of staff from an appropriate discipline 

• c) One practitioner representative working at a strategic level in the appropriate profession 

• d) A member of the Wellbeing Team 

9.5 The Panel may seek legal advice where appropriate. 

10. The Reasonable Adjustments in Practice Panel meeting 

10.1 The Reasonable Adjustment in Practice Panel meeting will proceed as follows: 

a) The Chair will open proceedings and will: 

• Establish the names and designations of everyone present on the panel  

• Explain the purpose and the possible outcomes. 

b) Consider the nature of the condition, the occupational health report, any other relevant information, and the application of the duty to make reasonable adjustment within the practice setting to assist it in the assessment of the appropriate reasonable adjustment for recommendation to the Placement Practice.  

c) Support and provide any information necessary for the Practice Placement to make the assessment and provide reasonable adjustments in practice. 

10.2 If there are grounds for a new Occupational Health referral then the student may be referred to Occupational Health for review of reasonable adjustment recommendations.  

10.3 In some cases, the Panel may decide that reasonable adjustments are not possible in the practice area and the student will then be referred to a Fitness to Practice Panel  

10.4 The secretary of the Reasonable Adjustment Panel shall produce a formal record of the meeting, to include: 

• a) The nature of the meeting 
• b) The evidence considered 
• c) The Panel’s decision  

10.5 The Secretary to the Panel will provide a letter to the applicant/student within 5 working days of the meeting of the Panel. 

11. Right of complaint for applicants 

11.1 Applicants whose offer of a place on the course is withdrawn as a result of the Panel’s decision, may use the complaints procedure outlined in the Admissions and Recruitment Policy. 

12. Right of appeal for students 

12.1 The student has a right of appeal against the decision of the Reasonable Adjustments in Practise Panel. Appeals will only be considered on the following grounds:  

• 12.1.1 Procedural error: where the process was not conducted in accordance with these Regulations. Procedural error shall include alleged administrative or clerical error which has materially affected the Panel’s decision, and bias in the operation of the procedure;  
• 12.1.2 Exceptional circumstances, illness, or other relevant factors were not made known at the time for good reason or were not properly taken into account; 
• 12.1.3 The decision of the Panel was manifestly unreasonable.  

12.2 Students should note that they cannot appeal against the professional judgment of the Panel.  

12.3 An appeal must be made in writing in accordance with section 14.3 of the Appeal Regulations and submitted within 10 working days of receipt of the Panel’s decision.