Multiple disadvantage


Multiple disadvantage refers to experience of a combination of intersecting problems including, but not limited to, homelessness, substance misuse, contact with the criminal justice system, mental ill health, domestic abuse. For many, their current circumstances are shaped by long-term experience of poverty, deprivation, trauma, abuse and neglect. There are frequently interconnected inequalities i.e. gender, race, disability which further compound the disadvantage experienced. A combination of factors mean this cohort are often the most vulnerable within our communities and experience the most harshest health inequalities.

People experiencing multiple disadvantage often face barriers to employment. The traditional recruitment processes used within health and social care are complex, daunting, and off-putting which deter people from applying.

Key challenges

  • Shift in organisational culture to think differently about approach to recruitment
  • Organisational approach to risk and associated management of it
  • Additional time and resource needed, in particular to provide people with support, if needed, during recruitment; on-boarding and once in post
  • Possible delays from point of job offer to starting in post if there are any issues relating to pre-employment checks
  • Immediate workforce pressures leading to focus on short term measures as opposed to longer term strategic planning and investment
  • Training and support for recruiting and line managers


  • People with lived experience of multiple disadvantage bring a unique insight and understanding of service provision
  • Increases diversity within the workforce bringing new perspectives and increasing innovation
  • Employment can aid individual recovery in terms of creating a sense of purpose and providing daily structure and routine
  • Providing opportunities for people at risk of negative health and wellbeing outcomes associated with unemployment via good employment thereby helping reduce health inequalities
  • Helps to bridge the gap between services and the people who use them, reducing stigma and prejudice
  • Improved retention rates and employee loyalty

Planning recruitment

  • Reduce length of job descriptions – consider what is essential for the role, particularly for entry level roles
  • Lengthy and complex application forms can discourage potential applicants. Think about whether a different format can be used

For example, Sheffield Health & Social Care NHS Foundation Trust have developed lots of useful guidance and resources to showcase how you can incorporate including people with lived experience into your recruitment practices.

  • Where is the role being advertised? The usual places health and social care roles are advertised may not be somewhere people would ordinarily look. Consider widening promotion of the role with the Voluntary, Community and Social Enterprise Sector/community groups
  • Reference the value of lived experience as an alternative to professional experience/formal qualifications

For example, Greater Manchester Mental Health NHS Foundation Trust include the following in their job adverts:

Applicants are encouraged to apply for posts at Greater Manchester Mental Health NHS Foundation Trust who have direct experience of mental health, learning disability or drug and alcohol services either as a service user or a carer

  • Consider putting on an informal session where people interested in the role can come and learn more about the roles and receive support to apply
  • It maybe useful to put together a video describing the role and what a day looks like in the role
  • Think about volunteers within the organisation. Is there an opportunity to encourage and support them to apply?

Interview phase

  • Provide the interview questions ahead of the interview date so candidates can prepare their answers
  • Be clear about at what point any criminal conviction disclosures will be discussed so people have time to prepare. More information regarding disclosure can be found here

Listen to an NHS employee’s experience of applying for jobs with a criminal record

  • Provide clear instructions (including public transport details/pictures) regarding the location of the interview
  • During the interview ask what, if any, support is needed from the organisation
  • If a candidate is unsuccessful following interview provide clear feedback in a timely manner with specific examples of areas to improve on
  • If a candidate is not appointable at this stage consider if there are any volunteering or pre-employment programmes that may be suitable and would support them into employment

Support once in post

Once in post think about the following:

  • Check regarding reasonable adjustments
  • Introduce a buddy system
  • Clearly defined role and responsibilities
  • Regular 1:1’s
  • Open door policy where open, honest communication is encouraged
  • Allow time off to attend personal appointments if required
  • Consider the workplace environment and culture – create inclusive workplace culture where different experiences and knowledge are equally valued amongst team members
  • Knowledge and awareness of vicarious trauma and burnout
  • Consider use of a wellness action plan

Find out more about Sandwell and Birmingham NHS Trust’s approach to inclusive recruitment here

Useful links and resources