Working in the NHS comes with a set of marvellous opportunities for learning and developing skills, both clinical and organisational.
Occupational therapy training in the UK tries to arm students with a wide range of not only clinical but organisational skills to help new graduates thrive in the workplace.
Holding a Band 6 case load within a community NHS setting in 2015 requires a resilience and skill set that demands excellent time management, organisation and prioritisation skill. Extremely high level executive functioning skills to formulate treatment plans, develop services, manage best value for money treatments and manage staff are necessary; In addition to gold standard clinical skills and professional reasoning are required to function day to day in the workplace and that is not taking into account the academic skills required to maintain up to date evidence based practice and registration requirements.
I’m sure there are things that I have missed out and that is the problem.
Academically speaking I am quite successful. I have two undergraduate degrees and got a first class honours in my occupational therapy degree and recently got a distinction level mark in a masters module. I have worked as an academic lecturer and held an occupational therapy post for the last seven years. I have good feedback from my patients and clinical work and love the development of a therapeutic relationship in complex cases.
My difficulties lie in my severe dyslexia. Dyslexia is a specific learning difficulty that is threatening to ruin my career and my love of occupational therapy.
I am a strategic thinker and excellent problem solver. I can develop caring, nurturing and motivational relationships with my patients and their families, find solutions to some of their very complex problems and help them through very difficult situations. When it comes to taking that work back to the office and the myriad of paperwork and bureaucracy that surrounds every patient contact within the NHS my brain falls to pieces. Paperwork remains paperwork within our underfunded service. Technology is basic and unavailable to most clinicians except to record statistics.
The NHS in 2015 has a strong audit culture. Audit culture runs through the organisation from top to bottom with every auditable action having penalties for failure to comply. Audit is most dyslexics’ nightmare. Every filing error, every illegible entry within case notes, every t crossed and i dotted when your cognitive system refuses to acknowledge that t’s should be crosses and i’s should be dotted.
That is not to say that audit is not necessary because it most definitely does, standards need to be met to ensure patient safety and service quality. Audit held like a guillotine over the head of a dyslexic individual however, is not productive and motivational, it makes the situation worse and can actually be a form of intimidation and bullying.
The Disability Discrimination Act (1995) demands reasonable adjustments to be taken to accommodate disability in the workplace, and dyslexia is considered a disability. Line managers will often support an individual with their time management and note writing to the best of their ability and a service called Access to Work provides assessment to see if there are recommendations they can make in the workplace.
It all sounds great right?
In context these strategies might not be so easy to implement. The manager who is assisting you may be snowed under with their own workload. The help you have been prescribed is useful but it doesn’t increase processing speed within the workplace and their is a back load of work to be completed. The IT support you have been recommended may not function on the archaic devices you have in your place of work and up to a certain amount employers have to pay for aids from their own budget. This is a lot of extra work for smaller teams and can lead to feelings of inadequacy and guilt from the disabled individual and resentment and tension from managers and team members.
Dyslexia is an invisible disability that is easy to misinterpret as incompetence or laziness even in the eyes of the person with the condition. They will have often been told to “work smarter AND harder”, prioritise more effectively, plan their time more effectively and write everything down; however often employing these strategies can be more challenging than the workload itself. Imagine the exhaustion of a day concentrating hard on numerous tasks only to then realise the actual work hasn’t even started. Dyslexic people often experience this every day of their working lives. In addition, dyslexic people may often come with considerable “baggage” regarding their condition. Diagnosis later in life, after a childhood of being told you are “thick and stupid” can have damaging effects on a person’s sense of self worth and self efficacy.
I don’t have an answer to these problems. What I know as an occupational therapist is that OT’s are supposed to be positive about the potential of people with disabilities. If an OT who had no sight worked within our service we would not expect them to pick up a regular printed document and read it, we would not expect an individual who had limited mobility to sprint across the hospital. We would work hard to ensure an employee with a visible disability had all the assistance they needed to ensure their core OT skills could be put to the best possible use. The same needs to apply to specific learning difficulties.
Ableist culture exists with the NHS, even though we are probably one of the best placed employers to help tackle it. We are an able-centric culture because our culture is (hopefully) to care and carer workers are “not allowed” to be ill. We give it our all, for the good of the patients and the good of our service or we are vilified.
The experience I have had as a disabled employee in the NHS has only become problematic when it has become problematic for my service. I am currently in the process of my second Access to Work assessment to address my needs in the workplace but as I have written above their are some considerable barriers to the success of technologies in the current setting. I am still positive that I have a lot to give my service and that my clinical skills are worth fighting this disability for.
Sparkle Occupational Therapy 