Unmet communication needs
This review identified widespread barriers preventing equitable access to healthcare services for deaf people and people with hearing loss in the UK.
This section covers:
- Attitudes and awareness of communication needs
- Digital tools and technology
- Assisted listening systems
- Deaf awareness
- British Sign Language (BSL) interpreters
A survey of NHS patients in England found that 74% of sign language users, 76% of people who need a communication support professional, and 37% of people who need other reasonable adjustments experienced barriers to accessing information or communication when booking appointments.
For the same groups, 67%, 55% and 27% experienced barriers when being given a diagnosis, and 67%, 62% and 28% when being told about medication or treatment (RNID and SignHealth 2025).
Attitudes and awareness of communication needs
Access to healthcare for deaf people and people with hearing loss is mediated through healthcare professionals (HCPs) and staff, from administration of appointment systems to communication within an appointment or consultation.
Whether staff are aware of the communication needs of deaf people and people with hearing loss, and how they approach those needs, significantly impacts access to healthcare.
For example, the attitudes of staff are a significant contributor to deaf people and people with hearing loss deciding not to ask for accessible information (Healthwatch Walsall 2024).
49% of deaf people and people with hearing loss were dissatisfied or very dissatisfied with healthcare staff’s communication skills (Parmar et al. 2025).
People also frequently feel that HCPs are not aware of their communication needs. This may be because they have not been asked about their communication needs, that this has not been noted on their records, or that HCPs don’t check their records in advance, forcing them to constantly advocate for themselves (Healthwatch Brighton and Hove 2025, Healthwatch Middlesborough and Recar and Cleveland 2018, Healthwatch Sandwell 2023, Parmar et al. 2025, Terry, Meara and England 2024).
70% of people had never been asked about their communication needs when accessing NHS care, despite this being required under the Accessible Information Standard (AIS).
There is also a disconnect between HCP and patient perspectives on this issue: 85% of HCPs said they knew how to find out whether a patient had communication needs, but 77% of deaf people and people with hearing loss said that HCPs had rarely or never been made aware of their information or communication needs before they met (RNID and SignHealth 2025).
For HCPs leaving training, awareness of the needs of patients who are deaf or have hearing loss may rely on how much experience they happened to have during training (Nolan-Bryant and Lockwood 2023).
These issues are found throughout the UK.
- Only 29% of people in Suffolk always had their communication needs met by staff, over half of people always had to ask for their communication needs to be met by HCPs, and no deaf people said their communication needs were met without asking (Healthwatch Suffolk 2023).
- In Buckinghamshire, only 21% of people surveyed knew they could ask for a flag to be put on their medical records (Healthwatch Bucks 2023).
- In Bexley, 46% of people surveyed were unsure if their GP was aware of their hearing loss (Healthwatch Bexley 2020). Problems can also stem from GP surgeries failing to have sufficient systems in place to alert staff to patients’ communication needs, and a lack of awareness of how to support those needs (Healthwatch East Riding of Yorkshire and Kingston upon Hull 2022).
A mystery shopping exercise in 34 NHS and social care settings in Wokingham Borough found a general lack of communication support, awareness of communication needs, and accessible information.
Only 23% provided “communication support” for the deaf mystery shoppers. Staff exhibited problematic behaviours such as continuing to talk after being told the person speaking to them was deaf, asking if someone could come in to help them, and saying “I give up”.
The only information about accessibility for deaf people were signs advertising hearing loops available ‘on request’, and none had visual alerts calling people to appointments (Healthwatch Wokingham 2018).
Deaf sign language users also report struggling to use 999 services, exacerbated by high emotional stress and lack of awareness from 999 operators (Foltz and Shank 2020). Some felt 999 services worked well, but others such as 111 were still too complex (Healthwatch Rotherham 2024).
Specialist services can also be inaccessible. One study reported negative experiences of maternity care such as being unable to fully communicate with staff during labour (Hall et al. 2018).
Within audiology, people with hearing loss described problems such as the audiologist asking them questions while they were not wearing their hearing aids or not making eye contact while speaking (Parmar 2022).
Deaf people experience “inadequate or uncertain linguistic access” during audiology appointments (Hulme, Young and Munro 2021).
Access to mental health services is inequitable, shaped by issues such as a lack of accessible information, delays to referral pathways, and poor deaf awareness (SignHealth 2023). Provision of accessible services may also be uneven across the UK, as demonstrated by the lack of deaf mental health services in Wales (Terry and Robins-Talbot 2024).
Another area of concern is staff awareness of NHS England’s Accessible Information Standard (AIS). RNID and SignHealth (2025) found that 32% of HCPs surveyed in England were unaware of the AIS, and not all those who were aware were able to correctly describe its purpose.
Only 21% of people who are deaf or have hearing loss were aware of the AIS. Equivalent data is needed for Scotland, Wales and Northern Ireland.
There’s a huge knowledge gap for healthcare services in terms of how to support deaf patients. In nursing school, there were no classes about hearing aid care and how to communicate with deaf patients, even though the majority of the elderly population has hearing loss.
Caitlin – deaf patient, a nursing student and an intensive care unit (ICU) nurse
There were some examples of good practice (Healthwatch Lewisham 2016, Healthwatch Surrey 2017, Parmar et al. 2025).
In Bexley, over 90% of respondents felt their audiologists treated them with dignity and respect, communicating in an appropriate way (Healthwatch Bexley, 2020). However, these were isolated cases.
Deaf people and people with hearing loss are currently unable to be confident that staff will know about, understand, and meet their communication needs.
There is a clear need for more consistent awareness of communication needs and implementation of the AIS.
Digital tools and technology
Some studies touched on HCP awareness of appropriate digital communication technologies when working with deaf people and people with hearing loss.
How health services use technology can strongly affect whether they are accessible.
For example, a common problem reported was GP surgeries relying on audio or one-way communication tools, requiring phone calls to book appointments, or sending text messages to deaf people, but not allowing them to reply in a written format (Alhusein et al. 2018, Healthwatch Blackpool 2025, Healthwatch Bucks 2023, Healthwatch Lancashire 2025, Healthwatch Rochdale 2025a and 2025b, Parmar et al. 2025).
This could still be the case if medical records showed a person was deaf and could not be contacted by phone (Healthwatch Brighton and Hove 2024).
I spent years explaining to the GP surgery that I can’t access phone calls, but they would always forget that they needed to text me. When the surgery would phone me all the time, it just made me feel rubbish and very frustrated because I didn’t know what they wanted and couldn’t find out”
– Sapphire, BSL user working in the NHS
These practices presented a barrier to deaf people and people with hearing loss managing their own care, sometimes having to rely on friends and family to contact health services instead (Healthwatch East Riding of Yorkshire and Kingston upon Hull 2022).
When deaf people and people with hearing loss are unable to make or answer phone calls, they may be removed from waiting lists, or miss appointments (Healthwatch Rochdale 2025a, Healthwatch Gloucestershire 2022).
Other technologies that support access to healthcare may be used inconsistently.
For example, remote BSL interpretation via Video Relay Services (VRS) can be a valuable tool for deaf sign language users accessing health services, but rely on having stable WiFi connections and staff who are aware of how to work with patients using these technologies, which is not always the case (Healthwatch Bolton 2024, Healthwatch Bucks 2023, Healthwatch Lancashire 2025, Healthwatch Rochdale 2025b, Healthwatch Rotherham 2024, Healthwatch Warrington 2023, Parmar et al. 2025, Terry, Meara and England 2024).
While VRS can be a positive tool for deaf sign language users, 41% of sign language users report negative experiences when using VRS to access a GP or hospital appointment, related to issues such as bad connections and poor video quality, lack of interpreter availability, and HCPs not knowing how to use the technology (RNID and SignHealth 2025).
Assisted listening systems
Another type of communication technology is assisted listening systems, such as hearing loops.
This review identified a lack of knowledge and upkeep of assistive listening systems in healthcare contexts, even within Ear, Nose and Throat (ENT) and audiology.
64% of audiology receptions reported that assistive communication devices for deaf people and people with hearing loss were available, but only 42% of ENT clinic receptions.
Availability was highest in shared audiology/ENT receptions. Over 1 in 10 receptionists were not aware of existing facilities (Jama et al. 2020).
Deaf awareness
Within the category of attitudes and awareness, there are specific issues related to the needs of people who are deaf, and deaf sign language users.
Research suggests a generally low level of deaf awareness among healthcare professionals in the UK (Healthwatch Bucks 2023, Jama et al. 2020, Parmar et al. 2025, RNID and SignHealth 2025).
This includes knowledge of communication techniques such as facing deaf people while talking, making sure qualified BSL interpreters are available when needed, and being aware of cultural and linguistic norms around communication for deaf sign language users.
I often have to remind the doctor to face me when talking multiple times within the same appointment. I do understand that services are overwhelmed – I see that first-hand as a nurse. But communicating effectively with patients should be a standard of care no matter what, and it can be critical. We have to find ways to improve services so that they cater for deaf people’s communication needs. – Caitlin – deaf patient, a nursing student and an intensive care unit (ICU) nurse
Research suggests that HCPs may feel they are making appropriate accommodations for deaf people and people with hearing loss, but this can be based on flawed assumptions (Healthwatch Wokingham 2018, Parmar et al. 2025).
Communication strategies reported by HCPs included using written instructions and information, lip reading, speaking loudly, miming and using hand signals, and BSL interpretation by family members and carers, or even staff with some ability to use BSL (Alhusein et al. 2019, Parmar et al. 2025, Healthwatch Rochdale 2025a).
Some of these strategies may be appropriate in some cases, such as writing information down, whereas others should never be used, such as asking family members to interpret.
These studies did not include data about whether HCPs had asked deaf sign language users for their communication preferences, or how/if they had ensured information was fully understood.
There is a risk that HCPs over-estimate how much information is understood through lip reading or written English (Parmar et al 2025).
Deaf people and people with hearing loss use a wide range of communication techniques, and understanding each individual’s preferences is key: in Suffolk for example, 21% needed to lip read, 19% needed a BSL interpreter, and 17% needed written notes.
Other support needs included using Relay UK, hearing aids and implants, hearing loops, and deaf aware communication skills such as not speaking too quickly or quietly.
Deaf people may not be comfortable advocating for themselves, so proactive communication by HCPs to determine needs and preferences is required (Healthwatch Suffolk 2023).
BSL Interpreters
Access to communication support professionals is a necessity for many deaf people and people with hearing loss. This includes BSL interpreters, lipspeakers, Speech-to-Text Reporters, and note takers.
1 in 5 of NHS patients in England surveyed required a communication support professional (RNID and SignHealth 2026). It is the responsibility of healthcare services to provide these, but access to communication support is inconsistent, and research suggests HCPs often lack awareness of how to work effectively with interpreters.
67% of sign language users in England have been denied the information and communication support they need when accessing healthcare, while 80% of sign language users have experienced instances when a communication support professional failed to arrive for an appointment, despite the patient being told one had been booked for them (RNID and SignHealth 2025).
Research shows that access to BSL interpretation is inconsistent, with confusion about who is responsible for providing it.
Deaf sign language users frequently have to go without a qualified BSL interpreter, allow family or friends to interpret, or face delays while they wait for an interpreter to be arranged (Parmar et al. 2025, Healthwatch Bolton 2024, Healthwatch Brighton and Hove, 2024, Healthwatch Bucks 2023, Healthwatch Lewisham 2016, Healthwatch Middlesborough and Healthwatch Redcar and Cleveland 2018, Healthwatch Rotherham 2024, Healthwatch Sandwell 2023, Healthwatch Stoke on Trent 2016, RNID and SignHealth 2025, Terry Meara and England 2024).
In one study, 96% of people spoken to need an interpreter for medical appointments, but 93% had attended an appointment without one (Healthwatch Warrington 2023). Only 9% of people surveyed by Parmar et al. (2025) were satisfied or very satisfied with provision of BSL interpreters.
These issues are exacerbated for hospital and emergency care.
People are told that BSL interpreters are not available at short notice, or for longer periods of time such as surgery.
Standard interpreter booking times do not match the full timeline of care from admission to recovery, with significant consequences for sign language users’ wellbeing (Healthwatch Gloucestershire 2022, Healthwatch Rochdale 2025a and 2025b, RNID and SignHealth 2025, Terry Meara and England 2024).
One individual reported being in hospital for two weeks without an interpreter, while another was left distressed after waking up “disoriented, anxious, and without vital communication support” after an operation (Healthwatch Rochdale 2025b).
A sign language user surveyed by RNID and SignHealth (2025) was “stressed and panicked” after six days in hospital without an interpreter.
Moreover, HCPs may not be aware of how to work with interpreters or when they are required. There were multiple examples of this within the included studies:
- Hospital staff turned off a remote BSL interpretation service stating it was a breach of confidentiality (Healthwatch Lancashire 2025)
- HCPs unilaterally decided a deaf sign language user did not require an interpreter (Healthwatch Luton 2025)
- HCPs direct their attention to interpreters rather than the deaf person, or assume the interpreter is a carer or family member (Chatzidamiaos 2019, Healthwatch Leicester 2025)
- A hospital refused to provide an interpreter for a deaf woman who was a carer with Power of Attorney for her mother with advanced dementia (Healthwatch Rochdale 2025b)
HCPs may also not understand that deaf people may prefer specific interpreters, for example someone who speaks the same BSL dialect as them (Healthwatch Bolton), or who they have worked with before (Healthwatch Rochdale 2025a).
Interpreter provision also affects access; deaf people in North Wales, a small community with a small number of available interpreters, expressed concerns about having to use the same interpreters for sensitive medical appointments and other tasks outside healthcare (Reader et al. 2017).
The lack of reliable BSL interpreter provision can have significant impacts on people’s experiences of healthcare. This was demonstrated in a case study reported by Healthwatch Luton about two deaf people, Rosie and Jacob (not their real names).
Jacob experienced multiple health emergencies over several years, but was frequently left without a way to communicate due to a lack of BSL interpreter.
HCPs instead relied on Rosie, also deaf. This led to Jacob being excluded from his own care, and Rosie experiencing severe emotional distress managing unmet communication needs, including when Jacob’s life support was withdrawn (Healthwatch Luton 2025).