Disproportionate Burden in Healthcare — NHS Exemption Explained 2026

„Can my NHS organisation claim exemption from accessibility requirements?" That's a question many NHS managers ask when they realise how much work is needed to make their digital services accessible.

In this guide, we'll explain what disproportionate burden is, when NHS organisations can claim exemption, and how to assess and document it properly.

What is a disproportionate burden?

A disproportionate burden is an exemption from the duty to make reasonable adjustments (under the Equality Act 2010) or meet WCAG 2.2 Level AA (under PSBAR 2018) if the cost of compliance would be too high compared to the benefits.

The concept of disproportionate burden recognises that:

• Not all organisations can afford the cost of full accessibility
• Some adjustments may simply cost too much for the benefit they provide
• Essential services have a higher threshold for claiming exemption

When can NHS organisations claim a disproportionate burden?

NHS organisations can claim a disproportionate burden when the cost of compliance would be significantly higher than the benefits to patients.

Factors to consider:

1. Financial cost

How much would it cost to make your healthcare website accessible? Consider:

• Direct costs — development, testing, design
• Ongoing costs — maintenance, monitoring
• Training costs — staff training

2. Organisational resources

Can your NHS organisation afford the cost? Consider:

• Budget — do you have the budget to pay?
• Staff — do you have staff with the right skills?
• Time — do you have the time to implement changes?

3. Benefit to patients

How much would patients benefit? Consider:

• Number of patients — how many disabled patients would benefit?
• Impact on patients — how important is the service?
• Alternative access — is there another way to access the service?

4. Essential vs non-essential services

Essential services (like patient portals, appointment booking, test results) have a higher threshold for claiming exemption. Non-essential content may be easier to exempt.

What is NOT a disproportionate burden?

You cannot claim a disproportionate burden for:

• Basic accessibility features — alt text, colour contrast, keyboard accessibility
• Essential services — patient portals, appointment booking, test results
• New content — new pages, documents, and features
• Core functionality — key features like forms and transactions
• Compliance with basic WCAG A criteria — the minimum standard

How to assess a disproportionate burden

Step 1: Scan your website

Use the free UK HHS checker to scan your healthcare website against WCAG 2.2 Level AA. The report will show you all violations.

Step 2: Identify the cost of fixing each issue

Estimate the cost of fixing each issue:

• Development cost — how many hours?
• Testing cost — how much testing is needed?
• Ongoing cost — how much to maintain?

Step 3: Assess the benefit to patients

Consider how much patients would benefit from fixing each issue.

Step 4: Compare cost and benefit

If the cost is significantly higher than the benefit, you may be able to claim a disproportionate burden.

Step 5: Document your assessment

Document everything. This serves as evidence if challenged.

Disproportionate burden assessment — Template

Here is a free template for your disproportionate burden assessment:

What happens if you claim a disproportionate burden?

If you claim a disproportionate burden, you must:

1. Document your assessment

You must document your disproportionate burden assessment. This includes:

• What you assessed
• Why you concluded it was disproportionate
• What alternatives you considered

2. Publish a statement

You must publish a statement on your website explaining:

• Which parts are not accessible
• Why they are not accessible (disproportionate burden)
• How patients can access the information

3. Review regularly

You must review your disproportionate burden assessment regularly (at least once a year).

What are the risks of claiming a disproportionate burden?

Claiming a disproportionate burden has risks:

1. Challenge by the EHRC

The EHRC can challenge your disproportionate burden assessment. If they disagree, they can issue a non-discrimination notice.

2. Discrimination claims

Patients can challenge your assessment in a discrimination claim. If they win, you could be ordered to pay unlimited compensation.

3. Reputational damage

Claiming a disproportionate burden can lead to negative publicity and loss of patient trust.

4. Legal costs

Defending a challenge can be expensive, even if you win.

Frequently Asked Questions — Disproportionate Burden

Internal links — Healthcare Accessibility Resources