Definitions of Reasonable Adjustments (unofficial, but entirely reliable):

* The Employee: “Anything that allows me to do my job while never being inconvenienced again, ever.”

* The Manager: “Anything that doesn’t require rewriting the rota, or attending another meeting.”

* The Colleagues: “Anything that doesn’t mean I pick up your shifts, your caseload, or your endless sighs.”

* HR: “Anything we can paste into a policy document to demonstrate compliance without committing to action.”

* Employee Health & Wellbeing: “Anything that can be delivered in the form of a mindfulness webinar at 2pm on a Tuesday right in the middle of a clinic.”

Ah, ‘reasonable adjustments’. A phrase so slippery it could double as a banana skin on a corridor. The NHS loves it: simple enough to print on policy posters, vague enough to keep HR in full employment until the sun burns out (but not with enough staff to actually implement fair and reasonable adjustments).

The word ‘reasonable’ itself is the first trap. Reasonable to whom? The Trust? The line manager? The staff member who insists their desk be precisely 87cm high lest their lumbar spine crumble like a dunked Rich Tea? Or the patient waiting 14 months for an appointment, wondering if the whole system could do with a slightly more urgent adjustment of its own?

Let’s not forget the employee perspective. Many staff sincerely believe that their particular requirement - be it noise-cancelling headphones in a busy office or an emotional support cactus in the staff room - must surely outweigh such trivia as, say, seeing patients or the needs of their colleagues. After all, one can’t pour from an empty cup, and what better way to refill it than with a sit-stand desk, an additional tea break, and perhaps a personal Sherpa to carry the mug.

Meanwhile, managers (often unsuspecting clinicians who thought they’d signed up to fix frozen shoulders, not frozen rotas) are left playing referee. They must weigh the noble aim of inclusivity against the practicalities of departments already held together with duct tape and existential dread. Should Jenny be allowed to work exclusively from home because she finds the lighting ‘oppressive’? Is it fair that Dave insists on a bespoke ergonomic chair that costs more than the annual physio budget, when the waiting room still has furniture held together by hope and infection control wipes?

It’s not just about decisions, it’s also about secrecy. These managers are asked to adjust quietly, confidentially and compassionately the requirements of one employee’s wellbeing against the loud eye-rolling and unsolicited advice from the rest of the department. Like a clinician treating a patient with an OA knee who also has plantar fasciitis, every adjustment made in one area seems to flare up another. Add in the fact that the only training provided was a two-hour e-learning module written in 2009, and you have a recipe for managerial tendinopathy: chronic overload, no rest days, and very little prospect of healing.

There’s the awkward truth that not all reasonable adjustments marry happily. One staff member’s ADHD means they thrive on chatter, spontaneity, and flexible timekeeping (“I’ll get there… eventually”), while their autistic colleague flourishes with quiet, structure, and their day nailed down to the minute. The result? An occupational oxymoron: one person’s reasonable adjustment is the other’s sensory nightmare. Managers are left playing mediator, trying to harmonise oil and water with nothing more than a policy and hope that the next time will be easier, when the staff member inevitably leaves as soon as they are competent.

The cruel irony is that staff who genuinely need adjustments (the colleague with a progressive neurological condition, or the one recovering from surgery etc...) now find themselves queuing behind a mountain of dubious requests. Their legitimate needs risk being trivialised, dismissed, or endlessly delayed because the term ‘reasonable adjustments’ has been stretched further than an overzealous hamstring in a beginners Reformer Pilates class. For them, the process feels less like support and more like months of paperwork, inconsistent progress, and no guarantee of improvement.

All of this is neatly reinforced by society’s current obsession with permanent happiness and total comfort. We live in an age where the faintest whiff of inconvenience is treated like a red flag for occupational health, and where negative emotions are seen less as a normal part of being human and more as a sign you need a bespoke wellbeing strategy. Resilience? Overrated. Tolerance? Obsolete. And personal responsibility for managing your own adjustments? Why bother, when someone else can rearrange your role, dim the lights, and deliver your high-protein snacks right to your ergonomic throne? The idea that work might occasionally feel like…work…now seems positively archaic, as though suggesting someone with a stiff neck try moving it a little.

And patients? Ah yes, those mythical beings. One suspects they may not care whether their clinician uses a kneeling stool or a yoga ball, as long as someone actually shows up to see them before the NHS is no more...

In the end, ‘reasonable adjustments’ are a bit like evidence-based medicine: everyone agrees in principle, no one agrees in practice, and someone always ends up with a flowchart. Perhaps the only truly reasonable adjustment is to accept that nothing is reasonable, everything is an adjustment and, particularly in the NHS, all of it will require another committee meeting, another e-learning module, and a small miracle - or at least a strongly brewed cup of tea.

Now, I’ve spent far too long sitting on my bean bag writing this - I need a brew!

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