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Rethinking Workplace Adjustments: Gatekeepers, Power Trips, and the Subjectivity of ‘Reasonable’

By Daniel Morgan-Williams, Founding Director of Visualise Training and Consultancy

Working in the workplace adjustment space, we see this quite often. An employee requests an adjustment to remove a barrier, and instead of a constructive conversation, the request is blocked. The justification usually sounds familiar: “It’s not reasonable,” or “If we do it for you, we’ll have to do it for everyone.” But too often, what’s really happening isn’t about reasonableness at all — it’s about control. Line managers, HR teams, and senior leaders act as gatekeepers, making subjective calls on what counts as ‘reasonable.’ And yet, under the Equality Act, it isn’t ultimately their decision to define what’s reasonable — it’s the courts’.

This article explores two essential but often overlooked aspects of workplace adjustments: the gatekeeping behaviours that can turn adjustments into a power struggle, and the subjectivity trap of defining what “reasonable” really means. Along the way, we will consider examples from sensory loss — particularly visual impairment, tinnitus and hearing loss — to highlight how seemingly simple requests are frequently blocked, and why workplace assessments are a practical, objective way to resolve disputes and remove barriers.

The gatekeeper problem

Many disabled employees describe the process of requesting adjustments as daunting and exhausting. Rather than feeling supported, they feel they must convince a panel of sceptics. In too many cases, the people deciding — often line managers or HR staff — are not experts in disability or workplace barriers. Instead, they rely on personal judgement, assumptions, or organisational culture.

The result is gatekeeping. Adjustments are seen not as legal rights but as optional benefits that must be justified, rationed, or resisted. Phrases like “if we let you, everyone will want it” or “we’ve never done that before” become shields against change. While often presented as protecting fairness, the reality is these decisions can be about maintaining control, avoiding change, or simply not wanting to engage with the complexity of disability.

When control outweighs inclusion

In practice, this gatekeeping can feel like a power trip. An employee discloses their condition, explains the barrier they face, and requests a change, and instead of collaboration, they are met with suspicion or resistance. For example:

  • A member of staff with tinnitus asks to work from home two days a week to avoid a noisy open-plan office. The request is refused because “it wouldn’t be fair to the rest of the team.”
  • An employee with visual impairment asks for screen magnification software. The manager says, “It’s too expensive,” without checking the actual cost (often less than £100).
  • A worker with hearing loss requests captioning software for online meetings, but HR claims “we don’t support that platform.”
    In each case, the employee is left feeling dismissed, while the manager maintains their authority. The adjustment itself may have been low-cost, simple, and entirely reasonable. But the refusal becomes a statement of power: “I decide what you get.”

What the law says

The Equality Act 2010 is clear: employers have a duty to make reasonable adjustments where a disabled worker would otherwise be placed at a substantial disadvantage compared to non-disabled colleagues. These adjustments are not perks or privileges; they are legal entitlements.

The Act deliberately uses the term “reasonable” to allow flexibility across different organisations and circumstances. What is reasonable for a small employer may differ from what is reasonable for a multinational corporation. Factors include cost, practicality, and the effectiveness of the adjustment in removing disadvantage.

However, the law also makes it clear that it is not the line manager’s subjective opinion that decides reasonableness. If challenged, it is ultimately for an Employment Tribunal or court to determine whether an employer has complied with their duty. Too often, employers act as though they alone define what is reasonable, forgetting that their decisions can and will be scrutinised externally.

The subjectivity trap

The word “reasonable” is deceptively simple. In reality, it is one of the most contested aspects of workplace adjustments. Employers often hide behind this term, claiming that a request is “not reasonable” without providing evidence or exploring alternatives.

For example, some organisations still argue that home working is not reasonable, even when the pandemic proved otherwise. Others dismiss requests for specialist software or equipment as too costly without researching prices or considering funding support. Subjectivity leads to inconsistency: one employee might receive adjustments easily, while another in the same organisation is denied.

Tribunals repeatedly show how subjective employer decisions can be overturned. Recent cases have found that denying home working for employees with health conditions amounted to a failure to make reasonable adjustments. These rulings highlight the risk of leaving such decisions solely in the hands of internal gatekeepers.

Why blocking adjustments backfires

Blocking reasonable adjustments has significant consequences:

  • Legal risk: Employees can and do challenge refusals at tribunal, with employers facing damages, costs, and reputational harm.
  • Business impact: Skilled employees leave organisations that do not support them, leading to recruitment costs and loss of talent.
  • Workplace culture: Staff lose trust in leaders who dismiss or belittle adjustments, creating a culture of fear and disengagement.
    Perhaps most importantly, blocking adjustments undermines inclusion. It tells disabled staff that their needs are secondary, their barriers unimportant, and their contributions undervalued.
    Examples from sensory loss

Sensory loss provides clear illustrations of how adjustments can be misjudged:

  • Tinnitus: Dismissed as “just ringing in the ears,” yet it can severely affect concentration, sleep, and mental health. Reasonable adjustments may include quiet workspaces, home working, or sound-masking devices.
  • Hearing loss: In noisy offices, communication becomes exhausting. Adjustments such as captioning software, hearing loops, or quiet rooms can transform accessibility.
  • Visual impairment: Lighting, screen glare, and inaccessible technology create daily barriers. Adjustments include magnification software, screen readers, lighting control, and accessible documents.
    In all these cases, adjustments are often low-cost and practical. The real barrier is not financial but attitudinal — the reluctance of gatekeepers to act.

The role of workplace assessments

One of the most effective ways to avoid disputes and ensure compliance is through workplace assessments. These assessments provide an independent, expert view of what adjustments are appropriate. Rather than relying on subjective judgement, employers receive a clear report outlining barriers, solutions, and costs.

At Visualise Training and Consultancy, we carry out workplace assessments for people with visual impairment, hearing loss, and tinnitus every week. What we see, time and again, is that minor, simple adjustments make a huge difference — and prevent disputes before they arise. Assessments bring objectivity to a process that is too often clouded by subjectivity and power dynamics.

From gatekeepers to enablers

The fundamental shift required is cultural. Employers must move away from seeing adjustments as optional benefits controlled by gatekeepers, and towards recognising them as rights that enable inclusion. HR professionals and line managers should position themselves as enablers, working collaboratively with employees to remove barriers to success.

This means listening without judgement, seeking expert advice, and being open to change. It also means recognising that adjustments are not about giving someone an advantage, but about levelling the playing field. Fairness is not sameness — it is equity.

Conclusion

Reasonable adjustments are too often blocked by gatekeepers who see themselves as the final arbiters of what is reasonable. In reality, this power trip undermines inclusion, creates legal risk, and drives talent away. The subjectivity of “reasonable” makes it all the more important to approach adjustments with openness, evidence, and expert guidance.

Employers do not have the last word on what is reasonable — the law does. By embracing workplace assessments, listening to employees, and shifting from gatekeepers to enablers, organisations can create environments where disabled staff are supported, barriers are removed, and talent can thrive.

The question is not whether adjustments are reasonable, but whether employers are willing to step beyond subjectivity and power dynamics to build truly inclusive workplaces.

To find out more about making your organisation more accessible and inclusive for colleagues with hearing or sight loss, visit https://visualisetrainingandconsultancy.com/workplace-assessments/

Drop in Zoom Meeting


The Next Meeting – Thursday 4th December 2025 at 7pm

Our drop-in Zoom chats provide a good opportunity for the newly diagnosed to meet seasoned travelers and discuss all things KC. Anyone interested in Keratoconus is free to join us.

Register to take part- Here

Please join us to discuss all things KC. We are totally open with no pre planned agenda. Ours is a truly bottom up organisation run by members, all of whom have KC or a close connection. There are no silly questions. If you are thinking it, then there is sure to be someone else with a similar idea.

We hope to see you then.

Sight Villiage – London

Sight Village London 2025 – NEW VENUE

Sight Village is the UK’s leading exhibition and an integral part of the blind and low-vision landscape, attracting thousands of visitors eager to explore the latest technology, products, and support services. It offers a unique opportunity to discuss and engage with new innovations in a sensory-rich environment, where you can see, touch, and fully experience products and services.

Sight Village is delighted to announce our New Venue for London 2025, which will be held at the: 

ILEC Conference Centre, on: Tuesday 18th & Wednesday 19th November 2025:

Tuesday: Doors open at 10.00am until 4.00pm

Wednesday: Doors open at 9.30am until 3.30pm.

Stop by and say Hello

For more details visit the Website

  • From West Brompton Station (approx. 5 minutes)
    • Exit the station and turn left onto Lillie Road.
    • Walk straight along Lillie Road.
    • The ILEC Conference Centre is on your left, connected to the Ibis London Earls Court Hotel.


Waiting times for Keratoconus

Ken Pullum gave an interesting talk to the Keratoconus Group outlining his ideas for addressing the increasing problem of waiting times for appointments.

Not only is this obviously disruptive to patients, it’s a false economy. Ken explained that keratoconus is not regarded as clinically urgent because a delay in fitting a contact lens is not going to affect someone’s life expectancy. However, it greatly affects their quality of life. It starts to appear in late teens, early 20s, and consequently has a dramatic effect on a person’s ability to get started in life and raise a family.

A solution can easily be demonstrated to be cost-effective to the individual, enabling them to start a career and continue in employment when things get difficult; by harnessing the enthusiasm and awareness of community practices. It also benefits the state when the individual can continue working and paying taxes. The alternative is to be dependent on state welfare.

Reflections from the Specialist Keratoconus & Scleral Lens Symposium, Hertford 2025

By Dr Sangeetha Rao

Author’s note:
Dr Sangeetha Rao, an Ophthalmologist and new member of the Keratoconus Self-Help and Support Group, shares her reflections from the 2025 Specialist Keratoconus & Scleral Lens Symposium in Hertford, a weekend of learning, collaboration, and connection.

As a new member of the Keratoconus Self-Help and Support Group, attending the Specialist Keratoconus & Scleral Lens Symposium in Hertford this October was both eye-opening and a lot of fun (yes, pun very much intended!). I wasn’t sure what to expect: a gathering of clinicians, researchers, and industry experts, all focused on improving care for people living with keratoconus. Would I feel out of place, or would I come away with insights that could truly make a difference?

A particular highlight was Peter’s presentation on behalf of the KC Self-Help and Support Group. Seeing the group’s principles articulated so clearly and watching clinicians and industry representatives respond was inspiring. It reinforced that supporting patients goes far beyond clinical care: emotional, social, and psychological support is just as vital as lenses themselves. Discussions extended to carers and relatives, the ageing KC population, and the crucial role of Eye Clinic Liaison Officers (ECLOs) in bridging communication between clinics and patients.

Of course, the hands-on sessions stole the show for me. I got to fit and remove scleral lenses and even take an eye impression, a fantastic insight into the skill and precision required. While the symposium was a deep dive into lenses, having our group present alongside clinicians and industry professionals reminded me that the journey is truly a collaborative one. Seeing everyone engage highlighted how shared experiences, guidance, and support can make all the difference in a patient’s journey, reinforcing the mantra: people first, lenses second.

Watching how small adjustments in edge clearance, peripheral curves, or fluid reservoirs can dramatically affect comfort and vision was fascinating. I now have an even deeper appreciation for the patience and dedication of both clinicians and patients managing these lenses day-to-day.

The programme covered a wide range of topics:

  • RGP and hybrid lenses, including “piggyback” systems and soft skirts to improve centration and reduce complications.
  • Mini and full scleral lenses, with guidance on achieving optimal central clearance, avoiding limbal compression, and managing common issues like impingement, blanching, decentration, or fogging.
  • Therapeutic applications, from ocular surface disease to post-surgical care and conditions such as SJS/TEN, showing that scleral lenses are not just about vision—they can protect, rehabilitate, and even act as a pre-surgical safety net.

Hearing directly from long-term scleral lens wearers reminded me that technology is only part of the picture. Comfort, confidence, and quality of life matter just as much, and every lens tells a story about the person behind it.

The symposium reinforced the value of collaboration between clinicians, patients, and support groups in delivering truly patient-centred care. Through shared experiences, guidance, and support, we help people navigate keratoconus, so it doesn’t have to be a lonely journey.

As an ophthalmologist, this experience deepened my understanding of complex lens fitting and the challenges faced by patients, but it also reminded me that empathy, communication, and advocacy are just as vital as clinical expertise. And yes, I had fun along the way. The hands-on sessions were thrilling, the learning intense, and the speakers brought great energy and humour to every session.

Overall, Hertford was a powerful reminder of the progress being made in keratoconus care, the importance of putting people first, lenses second, and the value of a supportive community. I left inspired, motivated, and excited to bring these lessons into practice and to continue advocating for the Keratoconus community every step of the way.

£2.4m funding to develop non-invasive treatment for keratoconus

University of Liverpool researchers receive £2.4 million to advance a minimally invasive treatment for keratoconus, aiming to improve patient access and reduce NHS costs

Researchers at the University of Liverpool have secured over £2.4 million in funding to develop a novel, non-invasive treatment for keratoconus, a progressive eye condition that causes the cornea to become misshapen, leading to significant vision impairment or blindness. This innovative approach uses a new cross-linking agent applied painlessly under local anaesthetic, without the need to remove the corneal epithelium, offering a safer and more accessible alternative to current invasive treatments.

The project, led by Professor Rachel Williams, aims to make this treatment available in community optometry practices, reducing the need for specialist hospital settings and potentially lowering the financial burden on the NHS, a promising development for the future of healthcare.

Keratoconus costs over £400m in the UK

Keratoconus affects one in 2,000 individuals in the UK, with prevalence rising to 1 in 200 among South Asian populations. The condition typically develops between the ages of 12 and 40, impacting education, employment, and quality of life. Figures from 2022 indicated that keratoconus cost the NHS over £400 million.

Current treatments prevent the disease progression; however, they are invasive and carry risks, including infections and long-term tissue damage.

Rachel Williams, Professor of Ophthalmic Bioengineering at the University of Liverpool, led the Liverpool research team, including Drs Lucy BosworthHelen CauldbeckAngela Stainthorpe, and Tansi Khodai, who will use Medical Research Council (MRC) funding to develop and clinically translate a new, minimally invasive treatment that offers a safer, more accessible alternative, a collaborative effort that includes the audience in the process.

Professor Williams said: “Our approach uses a novel cross-linking agent that can be administered painlessly under local anaesthetic, without removing the corneal epithelium – a key source of discomfort and complications in current treatments. This innovation has the potential to change the patient care pathway radically, making treatment available in community optometry practices rather than requiring specialist hospital settings.”

Over £2m funding for new treatment

Preclinical studies have already demonstrated the safety and efficacy of the novel cross-linking agent treatment in vivo, showing no histological changes in the cornea or surrounding tissues, providing reassurance about its potential benefits.

The new formulation is applied using a suction ring and does not require the removal of protective surface tissue, making the procedure more straightforward and more comfortable. As a result, the treatment could significantly reduce the financial burden on the NHS, potentially saving millions of pounds annually.

The team have been awarded £2,498,485 by the MRC Developmental Pathway, building on proof-of-concept work made possible through Harmonised IAA funding from the University’s Research, Partnerships and Innovation (RPI) directorate. Professor Williams has also benefited from ongoing support from the University’s Enterprise team, which has played a crucial role in facilitating collaborations and securing additional funding for the project.

Professor Williams concluded: “This award enables us to take the crucial next steps toward commercialising the treatment. We aim to partner with industry to bring this innovation into clinical use, working closely with our collaborator, Dr Vito Romano from the University of Brescia, reducing the need for invasive surgeries and dramatically improving access to care for patients with keratoconus.”

Read original article here.

NIHR grant awarded to UCL scientist Dr. Shafi Balal for community sourced AI-powered keratoconus research

The National Institute for Health and Care Research (NIHR) have awarded Dr. Shafi Balal a prestigious Doctoral Fellowship at University College London (UCL).

The NIHR Doctoral Fellowship is a full-time award that supports individuals to undertake a PhD in an area of research within the NIHR’s remit.

The funding will support Dr. Balal in groundbreaking research on using artificial intelligence (AI) to develop a foundation model (KERAFound) to enhance the early diagnosis of keratoconus, a corneal condition affecting vision. Keratoconus, impacts around 1 in 375 people and causes the cornea to become irregular and cone like, leading to visual impairment. Early diagnosis and timely treatment are crucial to prevent progression and avoid the need for corneal transplant surgery.

Dr. Balal expressed his gratitude for the support, stating:

This grant will enable us to advance our research and bring innovative solutions to the forefront of eye care. We are excited to explore the potential of AI in improving patient outcomes and reducing healthcare costs. We are seeking large anterior segment datasets and welcome national and international collaboration.

Harnessing the power of a foundation model, KERAFound will be tested on a broad range of conditions beyond keratoconus, including infections, inherited disorders, and glaucoma. In addition, exploratory work will focus on systemic conditions—an emerging field known as “oculomics.”

Dr. Balal’s research will be conducted in collaboration with Moorfields Eye Hospital, where the largest number of keratoconus patients in Europe are treated in its Keratoconus Clinic.

The team will use data from INSIGHT, an NHS-led data initiative hosted by Moorfields, to create a cloud-based database of high-quality scans to train the AI algorithms, ensuring accurate and reliable results. The project will use deep learning techniques to develop AI tools capable of diagnosing early keratoconus and monitoring its progression. This initiative aims to significantly reduce waiting times for specialist appointments, which can currently be as long as 44 weeks. Overall, this should provide substantial benefits to patients and the NHS.

Anterior segment scan

The study will be the first to use AI and INSIGHT data to look at anterior scans of the front of the eye to show how the cornea is changing shape over time. Previous successful work with INSIGHT data has looked at retinal scans of the back of the eye and led to the release of the RETFound AI foundation model.

Original article by NIHR here: https://moorfieldsbrc.nihr.ac.uk/nihr-grant-awarded-to-ucl-scientist-for-community-sourced-ai-powered-keratoconus-research/

Strategies for Coping with KC

Keratoconus (KC) doesn’t just affect your vision – it can also impact your daily life and emotional well-being. Distorted eyesight from KC can interfere with tasks like reading, driving, or recognizing faces, often leading to frustration or anxiety. That’s why coping with keratoconus is about more than just treating the eyes; it’s about preserving your quality of life. The good news is that with the right strategies and support, many people with keratoconus continue to live full, meaningful lives. Below are five key coping strategies, each aimed at helping you protect your vision and your day-to-day quality of life. 

Read the full article on the NKCF Website

Autumn Meeting

Autumn Meeting
Saturday 25th October at 11am

Our autumn meeting will be held at the Moorfields Education Hub 1st Floor 15 Ebenezer Street, N1 7NG (the hub is opposite the main hospital).  Cross City Road and go up Provost Street to the next corner and the Hub is facing you on the left. Doors open at 10:30, and there will be coffee and biscuits before the meeting starts.

We have just heard that, due to unforeseen circumstance, our speaker Dr Waheeda Illahi will not be able to join us on 25th. We will be rescheduling her talk for our AGM in March. I’m sure you will be as disappointed as we are, but we very much hope you will still come to the meeting as planned. 
It will be a chance to meet others with KC and talk about your experiences, hear from some of our new trustees about what they have been doing recently, tell us what the KC Group means to you and what we should be doing in the future to improve life for everyone with keratoconus.

So that we know what numbers to expect, can you please confirm whether you will be attending. We look forward to seeing and hearing from you on 25th! 

We provide a complimentary sandwich lunch which is always a good opportunity to meet other members and share stories. If you are coming please let us know by emailing anne@kcgroup.org.uk or ‘phoning her on 020-8993 4759 so we can cater for numbers.