NHS Reasonable Adjustments Request Pack

A request that says how your health affects your work, how long, the specific changes you want and how each helps, with an offer of occupational health and evidence and a request for a meeting, a written outcome and a review date.

[Your address]
[Your email address and phone number]

14 October 2026

Chris Marlow, Ward Manager
Example NHS Foundation Trust

Dear Chris Marlow,

Subject: Request for reasonable adjustments - Priya Nair, Staff Nurse, Band 5

I am writing to ask for changes to my working arrangements because of my health.
I believe I may be covered by the definition of disability in the Equality Act 2010, and I am asking you to consider this as a request for reasonable adjustments under the Act and the trust's policy.

How my health affects me at work: I have a long-term inflammatory condition. Fatigue and joint pain are much worse when I work more than two long shifts in a row or move between nights and days with less than two days between. It affects my concentration late in a shift and my ability to do manual handling safely.
How long it has affected me: 12 months or more.
My current role and pattern: Staff nurse on a medical ward, long days (07:00 to 19:30) and nights on a four-week rota.

The changes I am asking for are:
1. No more than two long days in a row, and at least 48 hours between a run of nights and the next day shift.
   How it would help: It lets me recover between shifts, which keeps the fatigue and pain at a level where I can work safely.
   For how long: Permanent, reviewed after three months.
2. A 15 minute rest break in the first half of each long shift, in addition to my meal break.
   How it would help: A short rest early in the shift stops the pain building up to the point where I cannot do manual handling.
   For how long: Permanent.

What has been tried or is in place already: I have swapped shifts informally with colleagues for the last year, but it depends on who is available.

I can provide a letter from my GP and my own written statement if it would help, and I am happy to see occupational health.
Some of these changes are straightforward, so I ask that they are considered first, without waiting for further evidence, while any occupational health referral is arranged.

[Optional, if something urgent is needed now: While this is considered, I ask that (the urgent change) is put in place on a temporary basis.]

I would be grateful if you would:
- acknowledge this request and tell me who will deal with it;
- arrange a meeting with me to discuss it by [date];
- tell me in writing what is agreed, from when, and what is not agreed and why; and
- agree a date to review how the changes are working. I suggest 14 January 2027.

Please share details of my health only with the people who need them to put the changes in place, and let me see what will be said before it is shared.

Thank you for considering this.

Yours sincerely,

Priya Nair
Staff Nurse, Band 5

[cc: my trade union representative: delete if not needed]

[Delete this line before sending: check every bracketed item, check your trust's own policy and have your union or staff-side rep read it first.]

What you hold and what you could ask for, a list of what a useful letter from a GP or specialist covers, each change matched to its support, and a statement in your own words to adapt.

EVIDENCE LIST: Priya Nair, 14 October 2026

[This is for your own use. You decide what to share and with whom. NHS Employers says it is not always necessary to insist on evidence where it is obvious an adjustment would help, so you may not need all of this. Share only the medical detail needed to put the changes in place.]

1. What I already have
- [not yet] A fit note
- [have] A letter from my GP
- [not yet] A letter from a specialist or therapist
- [not yet] An occupational health report
- [not yet] A health passport or earlier adjustments record
- [have] My own written statement

2. What I could ask for, and from whom
- My GP, specialist or therapist: a short letter. Ask them what they think helps, rather than asking them to say whether the law applies. A useful letter says:
    a. what the condition is, so far as it matters at work (you decide how much detail);
    b. how it affects specific tasks, shifts or conditions at work;
    c. how long the effects are expected to last;
    d. what changes would help, and whether they should be reviewed.
- Occupational health: an assessment and report. Ask your manager for a copy of the referral letter, and see document 3 for questions.
- A health passport or an earlier adjustments record, if you have one. NHS Employers publishes an editable health passport that staff can share with a new line manager.
- My own statement: a page in my own words. A starting point is in section 4.

3. What each change I am asking for is supported by
1. No more than two long days in a row, and at least 48 hours between a run of nights and the next day shift
   Supported by: [letter / report / my statement / obvious from the job]
2. A 15 minute rest break in the first half of each long shift, in addition to my meal break
   Supported by: [letter / report / my statement / obvious from the job]

4. My own statement (a starting point)
I am Priya Nair, Staff Nurse, Band 5, at Example NHS Foundation Trust.
My health affects my work in this way: I have a long-term inflammatory condition. Fatigue and joint pain are much worse when I work more than two long shifts in a row or move between nights and days with less than two days between. It affects my concentration late in a shift and my ability to do manual handling safely.
It has lasted: 12 months or more.
What makes it harder: [specific tasks, times or conditions].
What helps: [what you do already, and what you need].
What I have tried: [changes you have made yourself, treatment, anything you have already agreed].

5. Keep in mind
- Keep your own copy of everything. Give copies, not originals.
- You do not have to share your whole medical history. Ask who will see a report before you consent to it going to your manager.
- Note the date you sent or handed over each item.

[Delete this line before sending: check every bracketed item, check your trust's own policy and have your union or staff-side rep read it first.]

What to ask your manager before a referral, questions you can ask to be put to occupational health, what to ask at the appointment about the report, and what to bring.

OCCUPATIONAL HEALTH: QUESTIONS AND PREPARATION (14 October 2026)

[Occupational health is independent clinical advice for your employer. The duty to make reasonable adjustments sits with the employer, not with occupational health. Referral processes, report sharing and timescales vary by trust, so ask. Use the parts that fit.]

1. Before the referral: what to ask your manager
- Why is the referral being made, and what are the questions to be put to occupational health?
- Please can I have a copy of the referral letter, so I can see what has been asked? (It is a reasonable thing to ask. We have not found a rule that says the trust must agree.)
- Please can the referral focus on how my health affects my ability to do my role, and not on medical detail my manager does not need?
- Can any of my requests be put in place now, while the referral is arranged? NHS Employers says a referral can delay things for the person and that managers should consider adjustments before asking for evidence.

2. Questions I would like the referral to put to occupational health
- In your opinion, is the person fit to carry out their role as it stands? If not, what is stopping them?
- Would the following changes help, and are they practical for the role?
    1. No more than two long days in a row, and at least 48 hours between a run of nights and the next day shift
    2. A 15 minute rest break in the first half of each long shift, in addition to my meal break
- Please consider the effect on: my hours or shift pattern (including nights and long shifts) and breaks and rest during the shift.
- Are there other adjustments you would recommend, including equipment or aids?
- How long are the effects expected to last, and when should the adjustments be reviewed?
- Is the person likely to need further assessment, and if so when?
- [Optional: whether the condition is likely to have a substantial and long-term effect on normal day-to-day activities is a legal question for the employer, but occupational health may be able to say how long the effects have lasted and are expected to last.]

3. At the appointment: what to ask occupational health
- Who will see the report, and can I see it first? Practice varies between trusts, so ask before you consent.
- What happens if I think something in the report is wrong?
- When will the report go to my manager, and what will it say about my recommended adjustments?
- Can you tell me what happens next and who puts the advice into practice?

4. What to bring and say
- My name and role: Priya Nair, Staff Nurse, Band 5.
- How it affects me at work: I have a long-term inflammatory condition. Fatigue and joint pain are much worse when I work more than two long shifts in a row or move between nights and days with less than two days between.
- How long: 12 months or more.
- What I have tried or is in place: I have swapped shifts informally with colleagues for the last year, but it depends on who is available.
- Medicines, treatment or letters I want to mention: [list]
- What I most need from this assessment: [one sentence]

5. After the appointment
- Note the date and what was said.
- Ask your manager when they will meet you to go through the report.
- If the advice is not acted on, see the review letters in document 5.

[Delete this line before sending: check every bracketed item, check your trust's own policy and have your union or staff-side rep read it first.]

An opening statement, each change with why it helps and a fall-back, answers to the replies you expect, questions to ask and what to agree before you leave.

ADJUSTMENTS MEETING: PREPARATION AND STATEMENT
Prepared 14 October 2026 for Priya Nair

[This is for your own preparation. You do not have to share more health detail than you are comfortable with. Only say what is true.]

1. Before the day
- Confirm the date, time, place and who will attend, and what the meeting is for.
- Ask whether you can bring Dana Reid. The statutory right to be accompanied applies to disciplinary and grievance hearings, so for this kind of meeting it depends on the trust's policy: ask.
- Take your request letter (document 1), any evidence (document 2) and this page.
- If you need an adjustment for the meeting itself (a break, written questions), ask for it in advance.

2. Opening statement (about a minute)
Thank you for meeting me. I have asked for some changes at work because of my health. In short: I have a long-term inflammatory condition. Fatigue and joint pain are much worse when I work more than two long shifts in a row or move between nights and days with less than two days between. I would like us to agree what will help, how it will work in practice, and when we will review it.

3. Each change, why it helps, and a fall-back
1. No more than two long days in a row, and at least 48 hours between a run of nights and the next day shift
   Why it helps: It lets me recover between shifts, which keeps the fatigue and pain at a level where I can work safely.
   If this exact change is not possible, I could accept: [fall-back] because [reason]
   Practical points: [cover, handover, rota, equipment]
2. A 15 minute rest break in the first half of each long shift, in addition to my meal break
   Why it helps: A short rest early in the shift stops the pain building up to the point where I cannot do manual handling.
   If this exact change is not possible, I could accept: [fall-back] because [reason]
   Practical points: [cover, handover, rota, equipment]

4. If concerns are raised
- They may say: We cannot cover the rota.
  You could say: Which shifts or tasks does it affect, and how often? I have thought about [swaps, a fixed pattern, tasks that can move]. ACAS says the employer should consider whether a step is practical, and should look for other reasonable ways to help if one is not.
- They may say: We need medical evidence first.
  You could say: I can provide [letter / report]. NHS Employers says it is not always necessary to insist on evidence where it is obvious that an adjustment would help, so could we put the simple changes in place now, and review once any evidence arrives?

5. Questions to ask
- What can be agreed today, and what needs a decision from someone else? Who, and by when?
- If any change is not agreed, what are the reasons, and what alternatives were considered?
- Can anything be put in place now on a temporary basis?
- Who will know about my health, and what will they be told?
- Will the trust's adjustments policy and any form or health passport be used? Can I have a copy?

6. Before you leave
- Agree in plain words what has been agreed, from when, who will do what, and the review date.
- Ask for it in writing. Offer to write the summary yourself and send it the same day.
- Note the date and anything that was said that is not in the summary.

[Delete this line before sending: check every bracketed item, check your trust's own policy and have your union or staff-side rep read it first.]

Three short letters: a chaser if you have not heard, a request to review adjustments already in place, and a request for reasons and reconsideration after a refusal or no action.

REVIEW AND ESCALATION LETTERS: 14 October 2026

Which one: Keep these for after you have sent your request. Letter A is the first you may need.

========== LETTER A: chaser (no reply) ==========
[Your address]

14 October 2026

Chris Marlow, Ward Manager
Example NHS Foundation Trust

Dear Chris Marlow,

Subject: My request for reasonable adjustments of 14 October 2026 - Priya Nair

I wrote on 14 October 2026 asking for changes at work because of my health. I have not yet received [a reply / a date for a meeting].

Please can you tell me by [date]:
- that you have my request, and who is dealing with it;
- when we can meet; and
- whether any of the changes can be put in place in the meantime.

[Optional: Your trust's adjustments policy may say how quickly requests are dealt with. If it does, quote it here.]

Yours sincerely,
Priya Nair

========== LETTER B: asking for a review ==========
[Your address]

14 October 2026

Chris Marlow, Ward Manager
Example NHS Foundation Trust

Dear Chris Marlow,

Subject: Review of my workplace adjustments - Priya Nair

Thank you for the adjustments agreed on [date]. I am writing because [they are no longer enough / something has changed / one of them is not working].

What has changed: [describe it with dates and examples]
What I am asking for now: [the change, and why it would help]

NHS Employers says people's needs can change over time. Could we meet to review the arrangements, with occupational health's advice if you think it would help, and agree a new date to look at them again?

Yours sincerely,
Priya Nair

========== LETTER C: after a refusal, or no action ==========
[Your address]

14 October 2026

Chris Marlow, Ward Manager
Example NHS Foundation Trust

Dear Chris Marlow,

Subject: Request for reasons and reconsideration - reasonable adjustments - Priya Nair

I asked for reasonable adjustments on 14 October 2026. On [date] I was told [the request was refused / nothing would be done / the request was delayed].

I would be grateful if you would give me, in writing:
- the reasons for the decision on each change I asked for;
- what alternatives were considered, and why they were not possible;
- what information the decision was based on, including any occupational health advice; and
- who made the decision, and how I can ask for it to be reviewed.

ACAS says an employer does not have to make an adjustment that is not reasonable, but should still look for other reasonable ways to support the person. I would like us to look at [the alternative you would accept] if my original request cannot be agreed.

I would like the decision to be reconsidered in the light of [new evidence / the occupational health report / the points above]. Please can this be looked at by [a more senior manager / HR].

[If this is not resolved, I may raise a formal grievance. Delete this line if you do not want to say so yet.]

Yours sincerely,
Priya Nair

[Delete before sending: ACAS says a person who does not get the adjustments they need could make a claim to an employment tribunal, and that using a grievance or appeal does not change the time limit. For most claims where the problem happened on or after 1 October 2026 the limit is 6 months minus 1 day, and notifying ACAS for early conciliation inside it pauses the clock. How the date is counted for a continuing failure can be complicated, so check it with ACAS, the Equality Advisory and Support Service or your union.]

[Delete this line before sending: check every bracketed item, check your trust's own policy and have your union or staff-side rep read it first.]

A short summary of how your health affects your work and what helps, to give a manager or paste into a health passport or adjustments form, with a review date.

MY ADJUSTMENTS SUMMARY
Priya Nair, Staff Nurse, Band 5, Example NHS Foundation Trust
Written 14 October 2026

[A one-page summary you can give to a manager, or paste into your trust's health passport or adjustments form. NHS Employers publishes an editable health passport for this, which you may prefer to use. Share only what you are comfortable with.]

How my health affects me at work
I have a long-term inflammatory condition. Fatigue and joint pain are much worse when I work more than two long shifts in a row or move between nights and days with less than two days between. It affects my concentration late in a shift and my ability to do manual handling safely.

What helps
- No more than two long days in a row, and at least 48 hours between a run of nights and the next day shift (Permanent, reviewed after three months)
- A 15 minute rest break in the first half of each long shift, in addition to my meal break (Permanent)

What makes things harder
- [tasks, times or conditions]

Day to day
- How I prefer to be told about changes to the rota or my duties: [in writing / in person / by email]
- If I am unwell at work: [what helps, who to tell]
- Who may be told about this, and what: [people and detail]

Agreed with
- Manager: Chris Marlow, Ward Manager
- Date agreed: [date]
- Review date: 14 January 2027

[Delete this line before sending: check every bracketed item, check your trust's own policy and have your union or staff-side rep read it first.]