Introduction
To use public services, people need information that they can understand. Whether it is understanding health information, navigating the benefits system or making informed decisions about care, everyone has the right to get clear, accessible communication.
When communication falls short, it creates significant barriers, undermines trust between organisations and the public, and can even result in serious harm. This is why, over the next five years in our strategy, effective communication between services and people will be an important theme running through our work.
Accessible communication is an issue affecting a large number of people. In the UK, at least 1 in 5 people have a long-term illness, impairment or disability, while many more have a temporary disability. This means that accessible communication must be a priority and part of standard practice across all public services.
‘Public services must be accessible to everyone for the system to be fair and equitable.’ Rebecca Hilsenrath KC (Hon), Chief Executive
Examples of accessible communication needs
People need accessible communication for many different reasons and these needs can change over time. Some need information in different formats, such as large print, or support like British Sign Language (BSL) interpreting. Others will have temporary communication needs after illness or injury, find it difficult to read and understand information, or do not speak English as their first language.
What organisations should do
By law, public services need to provide for people with accessible communication needs. They should not make assumptions about who needs accessible communication and should be prepared to provide it when needed. They should identify those needs early, record them clearly and act on them consistently.
- The Equality Act 2010 requires public services to make reasonable adjustments to make sure disabled people have the same access as everyone else to information and services. Under this Act, public services must also meet the Public Sector Equality Duty (PSED) and think about how they are promoting equality in their decision-making, policies and the services they provide.
- Regulations introduced in 2018 also set out the requirements for public sector websites and mobile applications to make sure information is accessible.
- The British Sign Language Act 2022 says BSL is an official language in Great Britain. While government departments are not required to translate all communications into BSL, they are now expected to actively consider when BSL should be used and to report on how they use and promote it in their public communications.
This is also recognised in the guidance organisations have in place. For example, the NHS accessible information standard sets out the specific requirements for organisations providing care. It says they must take steps to make sure disabled people and people with impairments or sensory loss receive information they can access and understand and get communication support if they need it. NHS England published a refreshed version of the standard in 2025.
Unfortunately, organisations do not always provide accessible communication or do not provide it as well as they should. There is growing evidence that systems are not always in place, guidance is not always followed and failings happen as a result.
In April 2025, RNID and SignHealth published ‘Still ignored: the fight for accessible healthcare’. The report said, ‘the NHS does not have the systems in place to fulfil the right to accessible healthcare for people who are deaf or have hearing loss’. Similarly, in November 2025, the Disability Unit at the Cabinet Office published ‘Locked Out’, a comprehensive report that highlighted the continuing exclusion of deaf and deafblind BSL users across health and social care in the UK.
Evidence from our casework
We are not a regulator and cannot enforce the law, but our unique perspective comes from hearing directly from people who experience problems with public services. We can spot when mistakes happen and see how the organisation could learn from them and put things right.
Effective communication is at the heart of good public service. When public services communicate openly, empathetically and effectively with the people who use them, it leads to a better experience and better outcomes. But evidence from our casework shows that organisations are not always meeting people’s accessible communication needs.
In our report on ‘End of life care: improving DNACPR conversations for everyone’, we found there was a lack of accessible information given to patients. People with learning disabilities told us the NHS should be ‘offering DNACPR information in easy read formats, providing audio versions for people with reading difficulties, proactively offering accessible materials without needing requests, [and] providing consistent, accessible information in doctor’s surgeries’. This was also reflected by healthcare professionals we spoke to who did not feel they had clear information, support and experience, especially when working with people with additional needs.
Failings happen when systems do not consistently identify, record or act on communication needs.This can have a significant impact on people’s lives. It can exclude people, make services less fair, less safe and less effective, and affect trust and confidence in public services.
The case summaries we share in this report provide examples of what happens when:
- accessible communication needs are not consistently identified, recorded or acted on
- legal duties and national standards are not followed in practice.
For the people affected, these failures in communication can cause significant pressure and worry in difficult situations, and can have serious, sometimes harmful, consequences.
What good practice looks like
When organisations respond to feedback and make improvements to their accessible communications, it makes a big difference to people’s lives.
For example, North Cheshire and Mersey NHS Foundation Trust (formerly Warrington and Halton Teaching Hospitals NHS Foundation Trust) worked with local advocacy groups and deaf people to improve its service after patients reported exclusion and barriers.
The Trust made several changes, including:
- digital alerts on patient records to raise communication needs
- staff alerts to inform teams when a deaf patient is admitted
- deaf awareness training for staff
- guides for patients on how to access interpreting and translation services
- a dashboard to track whether patients get the interpreters they need.
The Trust worked directly with deaf people by going to the local Deaf Club for quarterly reviews, testing ideas, and including people’s feedback in its action plans.
As a result, interpreter use increased by 50% in one year. Now 87% of deaf patients report being supported, as appropriate, with a BSL interpreter during their hospital appointment or stay, compared to just 5% before the changes. One patient said, ‘For the first time, I feel understood when I come to hospital.’
‘By working alongside our patients, in partnership with advocacy services, and using data and feedback to inform the way we do things, we have been able to embed meaningful, practical and person-centred practices. By involving patients in each step of their journey and removing communication barriers, we have enhanced our patient experience, reduced health inequalities and improved health outcomes.’ Susan Dean, Deputy Head of Patient Experience and Inclusion at NCM
Communication needs for deaf people are now part of the Trust-wide equality and health impact assessment process, meaning accessibility is built into everyday practice rather than treated as an extra.
This approach shows what all public services should aim to do:
- identify communication needs early
- put the right support in place as standard
- work in partnership with disabled people to develop solutions that meet their needs.