What Accessible Healthcare Really Means for Deaf Patients
When a Deaf patient asks for a British Sign Language (BSL) interpreter for a healthcare appointment, arranging one can sometimes be treated as the end of the accessibility process.
But booking an interpreter is not the same as ensuring that a patient can communicate effectively, understand what is happening and participate fully in decisions about their own healthcare.
A recent case reported by the BBC provides a stark reminder of what can happen when accessible communication breaks down.
According to the Parliamentary and Health Service Ombudsman (PHSO), a Deaf woman was given the wrong vaccination after attending her GP surgery without the BSL interpreting support she needed.
The patient, referred to as Samantha, had booked flu and Covid vaccinations for different weeks. She showed a nurse a note on her phone stating that she was there for the "flu jab only", but was given a Covid vaccination instead.
The PHSO said the surgery had failed to show her a BSL video which would have helped identify the error. The practice said it believed consent had been established through Samantha's grandmother, who had early-stage dementia and was not in the treatment room.
The Ombudsman subsequently recommended that the surgery apologise and compensate Samantha. The surgery has since contracted with a sign language interpreting company.
The individual circumstances of this case are important. But they also raise a much broader question for healthcare providers:
What does genuinely accessible communication look like for a Deaf patient?
Accessible communication is part of safe healthcare
Communication in healthcare is not an administrative nicety.
Patients need to understand symptoms, diagnoses, treatment options, medication, risks and instructions. Healthcare professionals need to understand the information patients give them. And patients need to be able to ask questions, express concerns and make informed decisions about their care.
The NHS England Accessible Information Standard exists to help ensure that people with a disability, impairment or sensory loss can access and understand information about NHS and adult social care services and receive the communication support they need. Importantly, the Standard explicitly connects communication support with people's ability to make decisions about their health, care and treatment, including giving or withholding consent.
For some Deaf patients, appropriate communication support will mean a professional BSL interpreter. For others, a different form of support may be more appropriate.
That distinction matters.
Start by asking the patient
Being Deaf does not tell a healthcare provider how someone communicates.
A Deaf person may use BSL. Another may lipread. Someone else may require a lipspeaker, Speech-to-Text Reporter (STTR), notetaker or another form of language support. A deafblind person may have different and highly individual communication requirements.
Written English should not automatically be assumed to be an appropriate substitute for BSL either. BSL is a language in its own right, with its own grammar and structure. Fluency in BSL does not necessarily mean someone will find complex written English an equally accessible way to discuss their healthcare.
This principle is reflected in NHS England's implementation guidance for the Accessible Information Standard: people should be asked to define their own information and communication needs rather than professionals making assumptions based on their disability.
That means accessible healthcare should begin with a simple question:
What communication support do you need?
And crucially, the answer needs to be recorded, shared appropriately and acted upon.
Remote or face-to-face? Choice still matters
Even once it has been established that a patient requires a BSL interpreter, there can be another important conversation to have.
How should that interpreting support be provided?
Remote BSL interpreting can offer considerable benefits. It can provide flexibility and may enable interpreting support to be arranged quickly where an appropriate interpreter cannot attend in person. But remote provision will not necessarily be the best choice for every person or every healthcare situation.
The nature of the appointment matters. So can the patient's communication preferences, the physical environment, technology, privacy and the complexity or sensitivity of the conversation. The important point is not that remote interpreting is inherently better or worse than face-to-face interpreting. It is that accessibility should be based on the communication needs of the person receiving care, rather than simply on whichever option is easiest to arrange.
Where there are different appropriate ways of meeting those needs, the Deaf patient's preferences should be part of the conversation.
Who the interpreter is can matter too
An interpreter is a qualified professional, not a participant in the patient's treatment. But that does not mean the identity of the interpreter is always irrelevant to the patient. NHS England's current Accessible Information Standard implementation guidance says that, where possible, organisations should use an individual's preferred interpreter or interpreters when requested.
It also says organisations should, wherever possible, meet requests for a male or female communication professional and for the same professional to provide support throughout a course of treatment. This becomes particularly significant during sensitive, invasive or intensive treatment. NHS England specifically identifies pregnancy and maternity care, sexual health, radiotherapy and chemotherapy, end-of-life care and mental health services as situations in which particular effort should be made to accommodate requests for continuity of professional language support.
Why might that continuity matter?
Consider a pregnancy involving numerous midwife appointments, scans and consultations. Or a patient undergoing months of cancer treatment. Each change of interpreter can mean working with somebody new during conversations that may be personal, complicated or emotionally difficult. Where the same interpreter, or a small consistent team, can appropriately support an ongoing course of treatment, the patient does not continually have to establish a new communication relationship.
Of course, providing a particular interpreter will not always be possible. Availability, suitability, professional boundaries and the requirements of individual assignments all have to be considered. But continuity and patient preference should not automatically be dismissed as irrelevant to accessible care.
They are factors worth planning for.
Tell the patient what has been arranged
There is another part of the process which is remarkably simple but can make an enormous difference: Tell the patient that communication support has been arranged.
At Interpreting Matters, we hear of Deaf people requesting an interpreter for an appointment but not being told whether one has actually been booked.
Think about what that means from the patient's perspective. They may already be worried about a diagnosis, procedure, scan, test result or treatment. Added to that is another uncertainty: Will I be able to communicate with anyone when I arrive?
A patient should not have to attend an important healthcare appointment hoping that the communication support they requested will materialise. Where appropriate and possible, confirming that an interpreter has been booked, whether the support will be remote or face-to-face, and who will be providing that support can remove unnecessary uncertainty and help the patient prepare for their appointment.
Accessibility begins before someone walks through the consulting-room door.
Family members are not a replacement for professional interpreters
The BBC report highlighted another troubling case investigated by the Ombudsman. Alan Graham, who was Deaf, was receiving hospital treatment. When an interpreter was unavailable, staff reportedly asked his teenage grandson to interpret serious medical information for the family, including telling Graham's Deaf daughter that her father might die.
This illustrates why simply finding someone who can communicate is not the same as providing appropriate professional language support. NHS England's guidance states that people who need communication using BSL, deafblind manual or other communication systems must be offered professional, registered language support. It also says family members and carers should generally not be relied upon to provide this support, because doing so can increase the risk of inaccuracies and affect the quality of care. There may also be implications for privacy, safety and safeguarding.
There can be circumstances in which an individual wants a family member or carer involved, particularly where highly personalised communication approaches are used. Patient preference remains important.
But that is very different from expecting a relative, and particularly a child, to take the place of a qualified language professional because appropriate support has not been arranged.
Professional interpreters work within established standards of competence, confidentiality and professional conduct. In healthcare, where conversations can affect treatment, consent and life-changing decisions, those safeguards matter.
Good accessibility needs a system, not a last-minute solution
One of the most useful aspects of the Accessible Information Standard is that it treats communication access as a process rather than an isolated task.
NHS England describes six essential steps:
Ask. Record. Flag. Share. Act. Review.
In practice, that means healthcare organisations should identify a person's communication needs, record them clearly, ensure those needs are visible to relevant staff, share the information appropriately through treatment and referral processes, meet the needs and review them regularly.
For Deaf patients requiring professional communication support, we would add another simple principle: Confirm.
Let the patient know what has been arranged.
If an interpreter has been booked, tell them.
If circumstances change, tell them.
If a preferred interpreter cannot be provided, communicate that rather than leaving the patient to discover it when they arrive.
The administrative process and the patient's experience of that process are not necessarily the same thing. A booking sitting successfully on a system may mean the task is complete administratively.
For the patient who has received no confirmation, uncertainty remains.
A practical accessibility checklist for healthcare providers
Before an appointment involving a Deaf or deafblind patient, healthcare teams can ask:
- Have we asked the patient what communication support they need?
- Have those requirements been recorded and flagged clearly?
- Have we avoided assumptions about how the patient communicates?
- If professional communication support is required, has an appropriately qualified and registered professional been arranged?
- Have we considered whether remote or face-to-face support is most appropriate, taking the patient's needs and preferences into account?
- Has the patient expressed a preference for a particular interpreter or gender of communication professional?
- For ongoing or sensitive treatment, can continuity of interpreting support reasonably be provided?
- Have we told the patient what has been arranged?
- If arrangements change, do we have an accessible way of telling them?
- Have relevant communication requirements been shared appropriately through referrals, handovers and ongoing care?
- Are we giving the appointment enough time for effective interpreted communication?
- Are we relying on a relative where professional communication support should instead be provided?
- Have we reviewed whether the patient's communication needs or preferences have changed?
None of these questions is particularly complicated.
Together, however, they can make the difference between communication access existing on paper and a patient actually experiencing accessible care.
When things improve, the difference can be measured
The Ombudsman's report did not only highlight examples of failure.
The BBC also reported the example of North Cheshire and Mersey NHS Foundation Trust, which worked with local advocacy groups and Deaf people to improve services after Deaf patients reported feeling excluded. The Trust introduced guidance explaining how patients could access interpreting and translation services. According to the report, use of interpreters subsequently increased by 50% in one year. That is an important reminder that these problems are not inevitable.
Healthcare organisations can listen to Deaf patients, examine their systems and make practical changes.
Beyond the booking
The recent cases reported by the Ombudsman are serious because they demonstrate that inaccessible communication can have consequences far beyond inconvenience or frustration. But improving accessibility requires us to look beyond one question:
"Has an interpreter been booked?"
Instead, healthcare providers can ask:
"Can this patient communicate effectively, understand the information they are being given, ask questions, express their wishes and participate fully in decisions about their own care?"
Those are very different measures of success.
A BSL interpreter booking may be one important part of achieving accessible healthcare. But genuine communication access starts with the individual, continues throughout their care and ends only when they have been given the same meaningful opportunity to understand and be understood as everyone else.
Resources:
https://www.england.nhs.uk/long-read/accessible-information-standard-implementation-guidance/
https://www.england.nhs.uk/accessible-information-standard/why-its-important/
https://www.bbc.co.uk/news/articles/cn8nmm51l49o