Beyond barriers to better health: improving communication pathways in primary care for Deaf patients

This report, "Beyond Barriers to Better Health”, explores the experiences of Deaf people accessing primary care services in Hertfordshire, including GP practices, pharmacies, dentists and opticians. The research involved focus groups at six Deaf clubs, a survey of 77 Deaf participants, and a survey of 28 primary care professionals. 

Overall findings

The report found that Deaf people experienced significant barriers when accessing primary care, particularly around communication. While some participants reported positive experiences, more than a quarter (28%) described their care as poor or very poor, often because communication difficulties led to delays in treatment, reduced understanding of medical advice, anxiety and a loss of independence. 

Many Deaf people reported difficulties booking appointments because services relied heavily on telephone systems. Patients often had to attend surgeries in person, ask family members or friends for assistance, or use written notes to communicate. Primary care staff also recognised that telephone-based systems created barriers and could result in missed appointments. 

Communication barriers

Communication was identified as the most significant challenge. Deaf patients reported difficulties lip-reading because staff frequently wore face masks, spoke while looking away, or communicated in noisy environments. Many participants said that healthcare providers continued to telephone them despite communication needs being clearly recorded. Some services sent text messages that patients could not reply to, creating additional barriers.

The most common communication methods offered were pen and paper and support from family members or friends. However, these approaches were not viewed as suitable long-term solutions, particularly for British Sign Language (BSL) users, as written English may not be their first language and relying on relatives reduced privacy and independence. 

Access to interpreters

The report found inconsistent access to BSL interpreters. Only around one third of Deaf participants reported being offered face-to-face BSL interpretation. Both patients and staff described frequent situations where interpreters were not booked, cancelled at short notice, or failed to attend appointments. Some participants reported receiving care without fully understanding information or being able to provide informed consent. 

Access to Video Relay Services (VRS) and Video Remote Interpreting (VRI) was also limited. Only 19% of participants reported access to these services, despite many seeing them as an effective way to overcome communication barriers. 

Digital exclusion

The report highlighted that digital solutions do not work for all Deaf people. Some participants struggled to use online consultation systems, the NHS App and Relay UK because of limited digital skills or difficulties using written English. As a result, some patients remained dependent on family members to access healthcare. 

Reasonable adjustments and staff awareness

Although some healthcare staff made positive adjustments, such as speaking clearly, offering quieter waiting areas or booking patients with familiar clinicians, these adjustments were inconsistent across services. Deaf participants wanted staff to understand their communication needs in advance and provide alternative ways to book appointments and receive information. 

More than half of primary care staff said they had not received training on supporting Deaf patients. Only a quarter were familiar with the NHS Accessible Information Standard, and fewer than 40% said they understood their responsibilities under the Equality Act 2010 regarding Deaf people. Staff themselves called for more Deaf-awareness and BSL training. 

Complaints and feedback

Many Deaf participants reported difficulties raising complaints because complaints procedures relied on written English rather than BSL. Some said they needed family members, interpreters or support workers to complain on their behalf, while others felt their concerns were not acted upon. Participants argued that complaints processes should be available in BSL and designed to be more accessible.