Case report highlights urgent communication gaps for deaf NHS patients

Deaf patients get a raw deal in NHS hospitals, suggests an illustrative case history of a deaf person's experience as an inpatient, published in the online journal BMJ Case Reports.

During his hospital stay, reasonable adjustments to facilitate access to services-a key tenet of UK disability legislation-weren't made; the need for a professional British Sign Language (BSL) interpreter wasn't recognized soon enough; and frontline staff weren't adequately trained in how to support him.

Unfortunately, this experience isn't unique as these issues are "well known" to deaf people using NHS services, say the report authors.

The man used BSL as his primary means of communication, but his notes referred only to an ability to lip read if someone spoke slowly and clearly.

After 3 days on the frailty assessment unit, he was deemed well enough and in possession of an appropriate package of care to be discharged home. This was based on his supposedly being able to lip read what staff were saying and agreeing to most questions they asked of him.

But his package of care wasn't adequate, added to which he had no family nearby to support him, facts only uncovered by a doctor with basic BSL. The man was therefore not discharged home that day.

Four days after admission, a professional interpreter was requested. In the interim the Interpreter on Wheels service (a portable iPad which can be used to video call a BSL interpreter) was sourced from outpatients to be used for future consultations.

But this service is only accessible during normal working hours, and an unstable internet connection and the man's poor eyesight hampered its use.

During his hospital stay, the man developed, and was treated for, an irregular and fast heart beat (fast atrial fibrillation) and required intravenous antibiotics for a chest infection. These were diagnosed clinically from blood tests and without formal communication with him.

He also received various other treatments ranging from medicine, to ward off deep vein thrombosis, to blood transfusion, for which fully informed consent is needed, note the report authors. Yet a professional BSL interpreter only arrived 11 days after he had been admitted.

A review of the man's recent clinic correspondence revealed that he required a BSL interpreter for all medical consultations. The correspondence also showed that he struggled to read English, had poor eyesight, and bilateral tremor, making reading and writing difficult for him. Yet staff had persistently tried to communicate with him using written materials.

"This case shows a pressing need for institutional change in the care of deaf patients," write the report authors. "[It] highlights issues well-known to the deaf population in the National Health Service"….including "a systemic gap in training for medical staff."

They point out: "The lack of an interpreter led to ineffective communication with the patient, since their own language was not used to take a history or explain proposed plans. If the patient had been discharged on the initial proposed date (day 3), it would have potentially risked an unsafe discharge."

And they highlight: "Patient-centred care relies on effective communication with the patient or relatives, and this should not, and cannot, be done in a language which is not their own."

Through the auspices of a BSL interpreter, the patient explained: "I feel that I am treated differently as a deaf patient. I think this is mainly due to everything taking more effort and extra steps."

Reflecting on his hospital stay, he added: "I did not understand a lot of the things that were happening to me and going on around me due to staff not being able to communicate with me. I did not fully know why I was initially admitted to hospital, and what I was being treated for during my stay. I was moved between different areas of the hospital without being told why and where I was going."

He concluded: "I think that BSL teaching to staff would be useful as a deaf patient. But I think this should only be for simple things and when an interpreter is not available, as it is a lot easier to communicate with an interpreter who can understand all the signs that I am signing back to them.

"I think that more deaf awareness teaching is needed for staff and this would help other deaf patients in the future."

Although this case report describes just one case, the report authors cite previous reports and research indicating that this patient's experience of NHS healthcare is far from unique.

In 2023, for example, The British Deaf Association condemned the 'life-threatening

communication failures' faced every day by deaf people in the NHS and called for mandatory BSL and deaf awareness training for frontline NHS staff.

And in 2025, the Royal National Institute for Deaf people reported that as many as 48% of BSL users didn't understand their diagnosis, and 53% didn't understand the outcome of their consultation.