CES Resistance
Clinical Enabling Support (CES) – Responding to Resistance
This crib sheet summarises common employer objections to Clinical Enabling Support (CES) requests and provides structured rebuttals. Each section includes the rationale employers may use, the legal position, evidence-based counters, model rebuttal wording, and a comparison table.
Objection 1: “CES is just admin, not clinical.”
1. Why They Say This
Employers may argue CES is routine clerical work, not a disability-related adjustment.
2. Legal Position
Equality Act 2010: duty arises where a disabled person is at substantial disadvantage. Case law confirms adjustments can resemble 'ordinary' measures but are reasonable if they remove a disability barrier.
3. Evidence-Based Counter
CES tasks (training portfolios, safeguarding, clinical correspondence) require higher-level input. Generic admin staff are not skilled or allocated to address disability barriers.
4. Model Rebuttal
“The Equality Act test is about disadvantage, not labels. My ADHD creates substantial disadvantage in admin tasks, which CES removes. CES is not duplication of admin but targeted clinical enabling support.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| 'Just admin' | Clinical admin = core to safety & governance | CES addresses higher-level clinical tasks |
| We already provide admin | Generic support ≠ disability-specific support | CES is in addition, targeted to barriers |
Objection 2: “Not reasonable in cost or practicability.”
1. Why They Say This
Employers may say budgets are tight or it sets a precedent.
2. Legal Position
Equality Act: Reasonableness judged at employer level, not local budgets. Other employees’ positions irrelevant. Case law (*Archibald 2004*, *Cordell 2012*) shows cost reasonableness must consider employer resources.
3. Evidence-Based Counter
CES costs £3.7–5.2k/year, frees ~250 hours of clinical time. With AtW, cost to Trust ~£1.5k. Net neutral or positive overall.
4. Model Rebuttal
“Reasonableness is judged at employer level resources. CES is cost-neutral/positive. The fact other staff do not get it is irrelevant – adjustments are individual.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| Too expensive | Cost considered at employer level; CES cost is modest | CES is cost-positive, net gain |
| Not practicable | AfC Band 4–5 roles exist | CES can be implemented easily |
| Other staff don’t get it | Duty is individual, not comparative | CES tailored to disability |
Objection 3: “Alternative adjustments are available.”
1. Why They Say This
Employers may propose dictation software, flexible deadlines, or reduced caseloads.
2. Legal Position
Equality Act: Effectiveness is the test (*Rowan 2008*). Case law (*Archibald 2004*) confirms adjustments should enable staff to perform to their best, not just 'get by'.
3. Evidence-Based Counter
Alternatives reduce service capacity or provide only partial support. CES removes the barrier while maintaining throughput.
4. Model Rebuttal
“Adjustments must be effective. Case law confirms they should enable staff to work to their best. CES ensures I meet clinical standards, unlike alternatives that reduce quality or capacity.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| Dictation software | Doesn’t organise, edit or track tasks | CES ensures complete clinical correspondence |
| Flexible deadlines | Delays care, increases backlog | CES enables timely safe work |
| Reduced caseload | Cuts patient access, burdens colleagues | CES keeps normal caseload with support |
Objection 4: “Access to Work should fund it, not us.”
1. Why They Say This
Employers may try to shift responsibility to AtW.
2. Legal Position
Equality Act: Duty lies with employer, cannot be delegated. *Archibald 2004* confirms proactive duty. *Cordell 2012* – cost must be weighed against resources. AtW supplements, doesn’t replace duty.
3. Evidence-Based Counter
CES reasonable without AtW. With AtW, Trust cost £1.5–1.8k. Employer remains legally responsible.
4. Model Rebuttal
“Duty cannot be delegated. AtW reduces cost but Trust must act. CES cost-effective with or without AtW.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| AtW should fund it | Employer duty is non-delegable | AtW makes it cheaper but duty remains |
| We can’t fund if AtW won’t | Cost judged against employer resources | CES affordable regardless |
| You must apply to AtW first | Duty is proactive, not conditional | AtW is supplementary |
Objection 5: “Admin tasks don’t affect your ability to be a clinician.”
1. Why They Say This
Employers may argue admin inefficiency is not disability disadvantage.
2. Legal Position
Equality Act: Substantial = more than minor. Admin = core clinical duty (safeguarding, revalidation). Case law: *Rowan 2008* (effectiveness) and *Archibald 2004* (serious disadvantage may need significant steps).
3. Evidence-Based Counter
Admin is part of clinical role. ADHD causes disproportionate disadvantage. CES enables equality in safe standards.
4. Model Rebuttal
“Clinical admin is integral to safety and governance. Because of ADHD I am at substantial disadvantage. CES removes that barrier and enables me to perform at required clinical standards.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| Admin isn’t clinical | Documentation is core duty | CES enables timely, accurate clinical records |
| Still can see patients | Delays/errors create risk | CES ensures safe timely care |
| Just slower | Slowness = substantial disadvantage | CES restores equality |
Objection 6: “We don’t have enough evidence of disadvantage.”
1. Why They Say This
Employers may demand proof beyond OH or AtW reports.
2. Legal Position
Equality Act: Duty arises if employer knows or ought reasonably to know of disadvantage. Case law: *Gallop 2013* (must make own judgment), *Rowan 2008* (adjustments must be effective), *Ridout 1998* (self-report evidence valid).
3. Evidence-Based Counter
ADHD research + OH/AtW evidence + clinician testimony = sufficient. Duty is anticipatory, not proof-based.
4. Model Rebuttal
“Knowledge, not absolute proof, triggers duty. Gallop confirms employers cannot hide behind OH wording. CES is proportionate and effective given what is known.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| No proof | Constructive knowledge is enough | CES proportionate to known disadvantage |
| OH didn’t say so | Employer must use judgment | Self-report + evidence suffices |
| Not enough data | Duty is proactive | CES effective regardless |
Objection 7: “Training tariff/funding isn’t for admin staff.”
1. Why They Say This
Employers may argue CES can’t be funded via E&T tariff.
2. Legal Position
Equality Act: Duty is independent of budget structures. *Cordell 2012* – cost vs resources. *Gallop 2013* – excuses don’t remove duty.
3. Evidence-Based Counter
Tariff ~£12–13k/trainee/year; CES cost small fraction. CES enables ARCP/e-portfolio, prevents costly delays.
4. Model Rebuttal
“Budget labels don’t override Equality Act duties. CES aligns with training tariff purpose. Even if tariff not used, Trust must fund reasonable adjustments.”
5. Mini Comparison Table
| Employer Position | Why It Fails | CES Response |
| Tariff not for admin | Duty applies regardless | CES = training-related, e-portfolio, ARCP |
| Funding diverts | Without CES, training undermined | CES ensures success, avoids remediation |
| No funding route | Excuses ≠ defence | AtW + Trust resources cover modest cost |
Addendum – Quick Reference Summary Table
This one-page table summarises the seven main employer objections to CES and provides a short counterpoint for quick reference.
| Employer Objection | Quick Counterpoint |
| “CES is just admin, not clinical.” | Admin tasks are core clinical duties (safeguarding, revalidation, clinical letters). CES targets disability-specific barriers, not generic admin. |
| “Not reasonable in cost or practicability.” | CES costs £3.7–5.2k/year, frees ~250 clinical hours; with AtW Trust pays ~£1.5k. Cost-neutral or positive at employer level. |
| “Alternative adjustments are available.” | Effectiveness is the test (Rowan 2008). CES removes barriers while maintaining clinical standards. Alternatives reduce capacity or quality. |
| “Access to Work should fund it, not us.” | Duty is the employer’s, non-delegable (Archibald 2004). AtW reduces cost but responsibility remains. |
| “Admin tasks don’t affect your ability to be a clinician.” | Clinical admin is integral to safe practice. ADHD causes substantial disadvantage in these tasks; CES removes that barrier. |
| “We don’t have enough evidence of disadvantage.” | Duty arises with knowledge or constructive knowledge (Gallop 2013). Self-report + OH/AtW evidence is sufficient. |
| “Training tariff/funding isn’t for admin staff.” | Budget labels don’t override Equality Act duty. CES aligns with training tariff purpose; even if tariff unused, Trust must fund adjustments. |
