18 areas for action for service providers and health and social care professionals, and 14 urgent improvements for deafblind people (BSL and English versions)

Question 1

Areas for action

Accepted Answer

All these actions are directed at the Department of Health and Social Care (DHSC) and NHS England, NHS Wales (GIG Cymru) and Scotland. Additional stakeholders are also mentioned for some recommendations.

1. Research

Directed at:

National Institute for Health and Care Research (NIHR) and other research funders

Conduct epidemiological studies (understanding patterns of disease prevalence and why) and secondary data analysis (looking at existing data from a different angle). The Sick Of It health survey should be repeated over time to gauge change in the health of the Deaf community.^{[footnote 1]}

Create best practice guidelines and policy development based on available research evidence. This includes social work guidelines for carrying out statutory duties.

Document the growing BSL vocabulary for health and social care terms.

Build capacity and support for deaf researchers and educators.

Establish a neuroscience programme of linguistic and cognitive research related to BSL, deaf and deafblind people, with emphasis on early intervention and prevention of language deprivation.

Establish a new sign language therapy profession.

Create and validate new clinical assessment tools in BSL to assess patients when a condition affects language, mood or cognition. This is because traditional diagnostic tools are not suitable, for example, for dementia patients.

2. Building a BSL workforce

Directed at:

professional bodies
universities and education providers
Department for Education (DfE)
Department for Work and Pensions (DWP)

Build BSL expertise for hearing and deaf staff.

Provide training in BSL and knowledge of Deaf and Deafblind culture to hearing professionals to improve service delivery.

Deliver training modules for health and social care professionals, including BSL and deaf awareness, and specialist health and social care modules for interpreters.

Address the lack of training and career progression for deaf, deafblind and other BSL users by developing a multi-year training action plan for leadership, commissioning and service delivery roles within health and social care.

Stop barriers to career progression, including manager awareness of the need for reasonable adjustments for disabled people in the workplace – also use apprenticeships to support access to higher education.^{[footnote 2]}

Ensure accessible, supported training and development opportunities for deaf and deafblind staff as part of the NHS Long-Term Workforce Plan.^{[footnote 3]}

Review the Access to Work scheme guidance to ensure provision for voluntary work and internships, which are often crucial pathways into health and social care work.^{[footnote 4]}

Review the criteria of the Disabled Students’ Allowance, which currently often prevents BSL users from fully accessing university-based training courses with professional work placements in health and social care, along with university statutory obligations under the Equality Act.^{[footnote 5]}

Establish mentorship programmes to encourage Black and ethnic minority BSL users to start careers in health and social care, in collaboration with Black and ethnic minority deaf organisations.

3. Deliver consistent services to BSL users in line with the Accessible Information Standard

Directed at:

Care Quality Commission (CQC)

Develop and implement checklists for accessibility requirements and Deaf cultural competency, including a BSL-specific checklist using templates as a starting point. The checklists will reduce single-point-of-failure issues and disruption to access if staff leave. For example, checklist items could include allowing for a longer appointment time or procedure for booking interpreters. Maternity checklists could cover prenatal, delivery and postnatal care, explicitly including care plans with deaf mothers-to-be and access for their deaf partners. A&E checklists could include how to triage communication needs.

All checklists should ensure that a deaf or deafblind person has a good understanding of what medication is for and how to take it.

Mandate that services have a planned procedure for flagging and booking BSL interpreters. The CQC should monitor this to ensure every staff member, from the day of induction, knows where to find accessibility checklists and planned procedures.

Collect audit data about the referral rate of BSL users. If they are underrepresented, investigate the reasons why and creating a plan to close the gap between deaf and hearing referrals.

4. BSL interpreting

Directed at:

Cabinet Office
DWP

Strengthen standards and regulations through statutory registration of BSL interpreters.

Make the role of BSL interpreter a protected title through statutory regulation to ensure that only those who meet nationally recognised standards of competence and ethics can practice.

Create a national plan to increase the number of BSL-English interpreters (BSL to and from English) and intralingual relay BSL interpreters (BSL provision by a deaf interpreter into another language or type of BSL). This can be through student bursaries with a requirement to work in public services for a minimum period after training or through apprenticeship and mentoring schemes, developed in conjunction with universities.

Create a formal system of supervision for trainees and newly qualified interpreters.

Increase representation and boost diversity within the interpreting profession by promoting training pathways for individuals from minority backgrounds.

Develop interpreter competence in health, mental health and social care settings. This can be through specialised training modules provided by universities or as part of continuous professional development, with basic and advanced interpreter training or related interpreting or translating research programmes. Areas of particular importance for training are interpreting for assessments of mental health, language, cognition and mental state.

Training modules should include cultural competency training in relation to interpreting for deaf minority groups within health and social care settings.

Create a career structure for interpreters by giving greater recognition to the specialist skills of experienced practitioners, through requirements for supervision and the establishment of registers of qualified supervisors with differential rates of pay.

Review interpreter pricing models. The relevant bodies in the interpreting industry should encourage more cost-effective provision for short appointments. Pricing models should reflect post-pandemic working practices, including remote working.

5. Tenders, contracts and service-level agreements for BSL interpretation

Directed at:

commissioners

Contracted agencies must have clear standards for quality control, monitoring and accountability to end the problem of inconsistent quality of BSL interpreting provision.

Require contracts to outline requirements for monitoring and evaluation, with key performance indicators. BSL provision must be specifically monitored and not considered under wider spoken language interpreting fulfilment rates.

Award contracts to specialist sign language agencies based in the BSL community such as agencies run by deaf people or interpreters (not to spoken language interpreting agencies – run by companies who have poor knowledge of the needs of the deaf and deafblind people). This would ensure greater fulfilment of BSL bookings, with fewer cancellations, greater cultural awareness and accessibility, and an accessible BSL complaints process for each agency.

Tenders must have higher awards for social value directly benefiting the BSL community.

Contracts should be awarded based on quality of service, not just price, which is a false economy, as low fulfilment rates create hidden medium- and longer-term costs.

Contracts must be awarded based on commitment to meeting local needs in terms of BSL variation and national culture. For example, video relay services in Wales should use interpreters from Wales or with knowledge of local signs and place names.

BSL users must be involved in the tender process and the evaluation of bids.

Use regional lots to encourage local or regional services to bid. This decreases risk in the supply chain.^{[footnote 6]}

Highly specialist work should have differentiated pricing for specialisms to include mental health or legal work, resulting in smoother appointment outcomes for services and users.

Contracts for BSL interpreting services must state that:

NRCPD-registered qualified BSL interpreters must always be provided^{[footnote 7]}
sign language interpreting agencies should provide intralingual relay interpreters and deafblind interpreters, or this must be separately contracted
minimum fulfilment rates are set at 98%
video relay services (VRS) should be a choice, not forced, with face-to-face preferred except in emergency or walk-in situations, or for phone and video consultations^{[footnote 8]}
provide an interpreter every day for ward rounds and clinical care if a deaf person is in hospital
sharing important information with agencies and interpreters in line with GDPR and BSL users’ consent via the booking app, such as name, sex or gender, purpose of appointment and any specific communication requirements or preferences to ensure a suitable interpreter is booked – interpreters must have sufficient information to make informed judgements about accepting bookings
agency complaints processes must be fully accessible in BSL
consider having BSL advocacy and service navigation built into contracts, and delivered by separate professionals

Key performance indicators must include:

whether a fully qualified and registered interpreter was provided
recording when a BSL user has requested a specific gender or sex of communication professionals and how often this was achieved
recording a BSL user’s preferred pool of 3 BSL interpreters and how often preferences are fulfilled
whether an in-person or remote interpreter was requested and how often this was achieved
fulfilment at different service levels such as emergency, short notice and appointments with over a week’s notice
monitoring of cancelled appointments
monitoring of the number of complaints and resolution, including delivery of feedback to interpreters
an annual report

Service-level agreements

New service-level agreements (SLAs) are required that are comprehensive, co-produced with deaf professionals, and standardised across providers. This will embed user-centred access standards, culturally competent delivery expectations, clear mechanisms for feedback, monitoring and accountability, and regular review.

These agreements must include:

interpreter qualification and registration standards (for example, NRCPD or RBSLI, deaf relay interpreters or interpreters for deafblind people)^{[footnote 9]}
define priority triggers and response timeframes – for example, emergency (A&E) within one hour, same-day urgent (for example, hospital ward rounds) within 4 hours, and routine confirmation within 2 working days
continuity planning: clear procedures for covering interpreter absence, sickness or last-minute cancellations – especially in hospital or emergency settings
specify user-led access indicators beyond generic fulfilment rates, including: preferred interpreter pools, gender or sex preference, communication needs
transparent reporting on how often user preferences are met
allow flexibility to request interpreters from outside contracted agencies when necessary (for example, for continuity or trust)
ensure complaints processes are accessible in BSL and feedback is responded to with accountability
outline escalation procedures: what happens when KPIs are missed, who is responsible and how BSL users are informed of outcomes
mandate SLA compliance audits with Deaf community involvement to assess whether the service is meeting real-world needs
define shared accountability between commissioners and providers for issues like interpreter mismatch, repeated cancellations or lack of availability

6. Care inspectorates

Directed at:

CQC
Care Inspectorate Wales (Arolygiaeth Gofal Cymru)
Care Inspectorate (Scotland)

Care inspectorates in each nation should implement training on the needs of deaf and deafblind people and BSL users. Inspectors must understand what a good model of BSL provision and accessibility looks like.

Develop guidelines for inspectors for best practice for care provision for deaf, deafblind and BSL users.

Assess how well services meet their cultural and communication needs. Inspectors need linguistic and cultural competence (with a level 6 qualification or equivalent BSL fluency) or to engage Deaf consultants to assist with inspections.

Enhance criteria to include compulsory inspection of sensory needs.

Work closely with the government’s BSL Advisory Board, deaf organisations and BSL experts and advocates from the community to better understand the challenges deaf and deafblind people face and how to provide effective services.

7. Accessible estates

Directed at:

NHS estate managers and property services
local authorities

Ensure videophone door entry systems are used instead of auditory intercoms in all NHS and local authority estates.

Include tactile buttons on intercoms which vibrate when the call is answered and braille to assist deafblind access.

Use visual displays and handheld tactile buzzers to prevent deaf and deafblind people from missing appointments because they are unaware their name is called. This could also reduce anxiety in waiting rooms.

Make subtitles available on hospital and waiting room TVs.

Consider accessible design, including optimal lighting and suitable waiting room seating for face-to-face BSL (spaced apart) and for deafblind tactile communication (spaced closely and facing each other).

8. Accessible BSL information

Directed at:

NHS Digital Services
NHS England Communications Directorate, including publications and patient information teams
NHS Trust communication teams and integrated care boards
adult social care directorates
DWP

Make online BSL resources available to enable one-stop access without searching.

Improve signposting to BSL translation or video relay services (VRS) via QR codes (type of barcode) and a visual logo.^{[footnote 11]}

Provide BSL translations or versions of NHS and social services’ information, leaflets and web pages – with a QR code to scan to access translations.

NHS

Information in BSL should include:

public health information
self-help resources
pictorial materials and BSL videos to assist NHS staff to explain common procedures and treatments, for example, managing diabetes, having an MRI scan or providing consent for surgery
targeted healthcare information for deaf Black, ethnic minority and LGBT+ populations presented by deaf people from the targeted community
resources specifically tailored to the needs of deaf and deafblind carers

Information in BSL should include:

care assessments, care packages, personal budgets and direct payments
Mental Health Act assessments
power of attorney and capacity assessment
adult and child safeguarding and protection
information for deaf parents
fostering and adoption
carer information

Additional actions

BSL guidance for translation and presentation of BSL information is required that stresses the principles of effective access and informed understanding. The information should be presented in a way that is truly meaningful and useful to the Deaf community. Information should be culturally and linguistically tailored and produced by and with deaf BSL users.

Monitor the quality of BSL information videos to ensure they provide true access and help create informed understanding. Contract deaf qualified and registered BSL translators. Contract deaf interpreters to monitor the quality of the BSL translation by professional peers. Access must be effective and provide the best possible chance of the audience understanding the information, going beyond ‘tick-box accessibility’.

Invest in the creation of bespoke BSL content, rather than relying solely on translations, to improve understanding.

9. Health prevention and promotion

Directed at:

Local authorities
private providers
social workers
not-for-profit organisations
deaf communications staff and advocates

A targeted approach is required to build stronger relationships with Deaf communities, including minority groups, through outreach, engagement and targeted healthcare workshops.

Depict deaf people for better relatability and impact in BSL public health messaging and videos.

Deliver health messages and mental health self-help materials in BSL in bespoke formats that are widely understood by the target audience.

Use alternative forms of community engagement to share critical health messages, such as through craft groups or baby and toddler groups.

Improve BSL users’ access to routine health checks and sessions focused on modifying health behaviours. For example, health check roadshows for deaf groups aged 40 and 50 years and over are recommended, where a BSL-proficient nurse is available for people to book in advance or walk in at advertised locations. If combined with a social gathering, there is often better uptake.

Advertise vaccination clinics with a BSL interpreter so that deaf people can attend together on a given date.

Offer video calls with a BSL-proficient diabetes nurse to people with diabetes.

Deliver weight management, stop smoking and antenatal groups directly in BSL and online for geographical reach.

10. Audiology and vision services

Directed at:

National Institute for Health and Care Excellence (NICE)
NHS audiology and ophthalmology services
private providers
professional bodies
educators

These services are a priority for improvement, with high numbers of deaf and deafblind users.

Update the NICE guidelines to inform best practice when providing audiology or vision services to deaf and deafblind BSL users.

Develop specific training and awareness for audiologists, hearing aid specialists and vision services professionals on BSL and Deaf cultural competence.

Require students to pass a module equivalent to BSL level 1 in all audiology courses.

11. Long-term conditions

Directed at:

GPs and NHS services
private healthcare providers in England, Wales and Scotland

Specialist support services should be established for deaf people with long-term conditions and multiple comorbidities (more than one disease or health condition).

Commission national dedicated NHS specialist services for BSL users (and their carers) with cancer, diabetes, heart conditions, stroke, dementia and brain injuries using a hub-and-spoke model (where a central service connects to localised care) of specialist teams supporting local provision.

Give BSL users better access to both direct BSL support and more effective access to mainstream provision for these conditions, in collaboration with charity providers and their services such as the Macmillan cancer model.

Provide affirmative, accessible care, emotional and psychological support by using BSL-proficient clinicians and BSL healthcare advocates to run these services. They understand BSL users’ unique needs and can offer culturally appropriate support, including telemedicine.

12. Neurological and neurodevelopmental conditions

Directed at:

UK government and commissioners in NHS, central and local government

We are mindful that the UK is facing a “neurology workforce crisis”.^{[footnote 12]} But without BSL pathways, people with neurological conditions are assessed via an interpreter and often not referred, misdiagnosed or diagnosed late. BSL fluency is required to understand brain injury or a mental health disorder.^{[footnote 13]}^{[footnote 14]}

Establish a national centrally commissioned service for neurological and neurodegenerative conditions, including brain injuries and dementia, offering post-diagnosis care and community neurorehabilitation and psychological input. The service should follow a hub-and-spoke model with both specialist provision and inreach support.

Establish national adult deaf clinical assessment and support pathways for autism and ADHD. In England, this could be within the frameworks provided by existing specialist BSL mental health service provision but access should not require a mental health diagnosis.

Develop BSL resources and coaching led by deaf and neurodivergent people and to ensure BSL access to post-diagnostic support. Accessible training pathways are required to encourage deaf people to train in this specialist area.

13. Mental health

Directed at:

NHS England (crisis and acute mental health teams)
DHSC adult and child community mental health services

Commissioners must develop national strategies with named strategic or policy leads for the delivery of targeted BSL mental health services.

In Scotland and Wales, prioritise the urgent development of specialist deaf mental health care for adults and children, including inpatient, community and primary mental health care.

Address service gaps in England, including transition services for young adults, community forensic teams and services and prison inreach for deaf women, psychiatric intensive care and early intervention, better prevention resources, specialist BSL support for addictions, eating disorders and trauma, and pathways and assessment tools for deaf people with language deprivation.^{[footnote 15]}

Provide psychological therapy in BSL for all nations. Practitioners should include those with cultural, race and LGBT+ competence.

Ensure all staff delivering direct BSL services have or are being supported to work towards level 3 BSL.

Set up national BSL VRS crisis helplines.

Develop suitable BSL social care placements and community support to reduce the length of inpatient stays.

Address gaps in eligibility criteria and referral processes that currently mean deaf people experience delays or cannot receive help until their mental health deteriorates further. A self-referral route is recommended for joint assessment with better coworking between local and specialist teams. Referral routes between services should be less complex. Primary mental health services for deaf people should refer to community mental health teams directly when there is a clear need for local service involvement.

Develop tools and assessment protocols suitable for assessing distress, mood, thought process disorders and cognition in deaf BSL users.

Provide and improve specialist neurodevelopmental assessment of autism and ADHD within specialist adult and child mental health teams.

Improve specialist neuropsychology provision to better detect brain disorders in BSL users who present to mental health services.

For Child and Adolescent Mental Health Service teams, provide neurodevelopmental psychology, occupational therapy, specialist sign language therapy and a deafblind lead practitioner.

14. Advocacy services

Directed at:

Local authority commissioners
local NHS Trusts
independent advocacy organisations such as Citizens Advice

Improve access to BSL-proficient advocacy services and health navigators to support deaf people in accessing their rights to equitable service provision.

Commission specialist advocacy services within local authorities and integrated care boards for deaf and deafblind individuals.

Provide advocates who are fluent in BSL and have a deep understanding of Deaf cultural, linguistic and literacy needs – to help people navigate services and ensure statutory rights are upheld.

Ensure access to BSL-proficient independent advocates in addition to BSL interpreters within statutory legal proceedings. Give clear guidance on their separate roles.^{[footnote 16]}

Review and expand the capacity and specialisation of existing advocacy services, such as Citizens Advice, to better meet the needs of deaf BSL users.^{[footnote 17]}

Directed at:

local authorities
Integrated Care Systems
British Association of Social Workers
education bodies
Court of Protection
DWP

Resume the statutory reporting of deaf registration data.

Expand protections and recognition under the Care Act 2014 to explicitly include BSL users and deaf individuals – similar to that granted deafblind individuals.

Expand BSL users’ eligibility for individual budgets or direct payments schemes under the Care Act 2014 – funding arrangements that allow disabled people to choose and pay for the support services that they need – to introduce a scheme similar to Australia’s National Disability Insurance Scheme. This would provide more comprehensive and individualised BSL interpretation for the settings listed in Annex C. Ensure that this provision is not means-tested.

Provide guidance to ensure social workers can carry out their statutory duties equitably for deaf people. Highlight the potential consequences and injustices of inaccessible and poorly informed provision for BSL users.

Ensure all public services add BSL to their list of languages for available translations – online and in public spaces.

Ensure there is a centralised information hub listing all BSL specialist intermediaries, advocates and other social work and care specialist professionals available to work with social workers, to enable them to carry out their responsibilities and duties with deaf and deafblind people.

Expand the current guidance on curriculum content for qualifying social workers, approved mental health professionals (AMHP) and best interests assessor (BIA) to include knowledge about and competencies in working with deaf and deafblind people.

Provide guidance for Court of Protection, capacity assessment or AMHP and BIA/deprivation of liberty standards, power of attorney, Department for Work and Pensions appointeeship and safeguarding procedures for people who use BSL. Strategies are needed to improve community awareness and accessible means of reporting abuse. There needs to be a greater awareness among professionals of the specific issues that deaf and deafblind BSL users face. This is so that a lack of access or deprived opportunities for communication are not mistaken for a lack of capacity. Stringent guidance about the use of interpreters in these contexts is required. Important documents and processes must be available in BSL. For example, POA certificate providers must know BSL.

Create a BSL-led information strategy to inform and promote the rights of BSL users, making them aware of social care eligibility, assessment and service provision.

16. Support for children and families

Directed at:

local authorities and DfE (social workers, sensory teams, those responsible for adult and child safeguarding)

Ensure better collaboration between non-specialist social workers and those who work in sensory teams specialising in working with deaf and deafblind people.

Review and lower thresholds for accepting referrals and the provision of assessment and services to ensure deaf children and families receive timely early intervention and support – even in the absence of additional disabilities or safeguarding concerns.

Consistently recognise, assess and support deaf children and families as ‘children in need’ as defined in section 17 of the Children Act 1989.

Provide comprehensive support services for deaf children, deaf parents and families, including BSL communication, access to Deaf role models, and parenting skills courses.

Ensure safeguarding provision for deaf children that pays attention to their language needs and preferences at all stages in the child protection process.

Ensure all child protection processes involving deaf parents are culturally and linguistically appropriate.

Promote consistency and proactive engagement within children’s services working groups across the UK.

Improve social workers’ understanding of social care needs for deaf children and families to enhance their contribution to education, health and care plans.

Provide BSL-accessible parenting courses, with specific attention to the needs of deaf parents at risk of family breakdown, including direct provision of parenting support in BSL.

Expand self-directed support or direct payments under the Care Act 2014 to include deaf parents.

Improve BSL access to the family courts and child protection processes for deaf parents.

Centralise funding for BSL interpreters for school parents’ evenings and make sure it does not come from the individual school’s budget or parents. Or enable all deaf parents to access Care Act 2014 direct payments to be used for this purpose.

For looked-after children, a new strategy must consider cultural matching and the BSL needs of deaf children in foster care to prevent language deprivation and to meet their Deaf identity needs.

Ensure that fostering and adoption professionals prioritise the placement of deaf children with deaf adults or BSL users.

Directed at:

private and not-for profit health and social care providers

Make it mandatory that private companies apply the same standards that are enshrined in the AIS and provide BSL interpretation to deaf patients who request it.

Ensure that private companies take steps to comply with the recommendations of this report, in the same way as the public and not-for-profit sectors.

18. Registration of births and deaths

Directed at:

Home Office
local authorities

Introduce remote BSL Video Relay Interpreting (VRI) to every Register Office.

Provide staff training on how to use VRI so BSL users can register a birth or death without communication difficulties on some of the most joyful or difficult occasions in their lives.

Provide in-person interpreting for those who need it.

Question 2

Urgent improvements for deafblind people

Accepted Answer

There are over 450,000 deafblind people in the UK. This is expected to increase to over 610,000 by 2035 due to an ageing population.

Our recommendations focus on deafblind people who communicate with BSL but are also relevant to deafblind people more broadly.

All these actions are directed at the Department of Health and Social Care (DHSC) and NHS England, NHS Wales (GIG Cymru) and NHS Scotland. Additional stakeholders are also mentioned for some recommendations.

1. Definition

Establish a co-ordinated 4-nations review considering the Nordic definition or hybrid approach by combining existing definitions in England and Wales with the Nordic framing and the World Health Organization’s international classification of functioning, disability and health (ICF) core sets. This will ensure clarity, rights-based recognition and consistent implementation across health and social care systems.^{[footnote 18]}^{[footnote 19]}^{[footnote 20]}^{[footnote 21]}

2. Consistent provision

Directed at:

DHSC, NHS and equivalents in Wales and Scotland
National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD) and Signature^{[footnote 22]}

There is a national crisis in provision for deafblind people. There are currently only 8 deafblind interpreters on the NRCPD in the UK. The main areas to solve to make the world easier for a deafblind person, helping them reach their full potential in the community and workforce, include the shortage of deafblind interpreters, communicator guides, advocates and specialist deafblind rehabilitation services, and the roll out of Accessible Information Standards (AIS) across all public services.

Please also see section 6 for more information about the AIS.

Provide common standards and consistent specialist provision within the health and social care systems for deaf and deafblind people, within the different legal frameworks for England, Scotland and Wales.

Urgently increase the number of deafblind interpreters (BSL interpreters who are trained to work with deafblind people using adapted and tactile forms of BSL) and specialist communicator guides (a professional who assist with communication, navigation and environmental awareness) to give more autonomy to deafblind individuals and avoid reliance on family members and friends.

Speed up the rollout of tactile BSL and qualifications, and awareness training for interpreters.

3. Data

Directed at:

Department for Education (DfE)
local authorities

Better quality data about the needs of deafblind children should be collected by the Department of Education and local authorities. Good quality and accurate data from large sample sizes is important to track patterns in populations and can also be used to lobby for additional services where there are challenges and concerning trends.

Include a separate disability category for ‘deafblindness/dual sensory loss’ in all public service data collection about disability.

Collect information about whether BSL is the preferred language of deafblind people.

Implement the statutory guidance to local authorities to identify, contact and keep a record of all deafblind people in their catchment area.

4. Research

Directed at:

NIHR and other research funders

Prioritise funding for research on the needs of deafblind people, focusing on the following themes:

psychosocial impact and outcomes for deafblind people in relation to health, social care, employment, rehabilitation, emotional and life adjustment, and the cognitive load and fatigue related to deafblindness^{[footnote 23]}
effective deafblind sign language communication, including the use of protactile principles within tactile BSL, to reduce communication isolation and improve integration between deaf and deafblind BSL users^{[footnote 24]}
language development in deafblind children and the prevention of language deprivation through teaching of BSL and its tactile forms by deaf and deafblind adults

5. Deafblind children

Directed at:

cross-government departments
NIHR
DfE
DWP
local authorities

Expert sign language users must be involved at every stage of the care pathway so that all deafblind children, including those who use BSL and its tactile forms, can meet their potential as learners, community members and citizens.

Research into risk and resilience factors affecting language deprivation in deafblind children. View language deprivation as not a result of dual sensory impairment but due to a lack of tailored language development support for deafblind children, including the use of tactile and other forms of BSL.

Review and establish developmental pathways involving joint planning by education, health and social care commissioners. This should include funded provision for parents to learn BSL, to learn intervention strategies to support their child’s language and cognitive development, and provide emotional and psychological support for deafblind children and families.

Provide BSL for all families and their deaf or deafblind children immediately following diagnosis alongside access to hearing technology. Many deaf children have syndromes that cause sight loss later in life so it is essential that they have BSL so that later they can use tactile BSL and benefit from the support of the Deaf community and Deafblind community – if they wish to as they lose their sight. Early BSL is essential as part of a bilingual approach, as it may be too late to learn visual BSL once they have lost their sight.

Provide best practice guidance for supporting a child’s transition from childhood into adulthood, such as starting and leaving school, moving into work, and transitions within the health or social care systems.

Allocate central funding to enable every local authority to provide multi-sensory impairment (MSI) teachers and intervenors to ensure that every deafblind child gets the support they need to thrive.

Develop training pathways for MSI teachers and intervenors – require existing and future practitioners to become proficient in BSL and its tactile forms as part of a mandatory qualification as specialist teachers of deafblind children and young people.

Build a workforce of deafblind and deaf educators for deafblind children – this is known as direct BSL provision.

Ensure that deafblind people who wish to train as educators or intervenors are provided with the reasonable adjustments and Access to Work (AtW) support tailored for deafblind people, which is not currently available – as the AtW system is designed for people who are deaf or blind but not both.

6. Consistently applying Accessible Information Standards for deafblind people

Directed at:

CQC
commissioners
interpreting agencies
service providers

All NHS, DHSC and private sector providers should be required to show evidence of compliance with the AIS and the Equality Act within tendering, contracts and service-level agreements. The standards should be consistently implemented for deafblind people, but currently lack means of enforcement. Section 95, which gives new powers to the Secretary of State to enforce the AIS across the NHS, has not been enacted. The refreshed AIS 2025 included self-assessment frameworks as a step toward mandatory AIS.

Ensure that the deafblind person receives support from their named preferred qualified interpreter and communicator guide. Working with familiar people is essential for good communication.

Commission BSL specialist interpreting agencies and deafblind specialist interpreting agencies. Spoken language interpreter agencies should not be commissioned to provide deafblind services as they lack expertise and knowledge. Only agencies from within the BSL community should be contracted.

Provide in-person BSL provision for deafblind people who require it, as remote video relay interpreting services are often completely inaccessible for this group.

Offer double or triple-length health or social care appointments to allow time for effective deafblind communication, which can be slower.

Offer tailored AIS accommodations for deafblind people and ensure that solutions offered to deaf or blind people are made accessible. For example, text solutions for deaf people must also be accessible for those with low vision. Accessible digital and written communication must include large print, digital and braille formats. Images, websites and BSL videos should have visual descriptions and alternative text. BSL videos should be shown against high-contrast backgrounds and provide a link to an English transcript with visual descriptions of the video in a format compatible with braille readers and screen readers.

Require service providers to offer AIS provision, such as booking human assistance and communicator guides, to help a deafblind person to get to and from their home to the appointment.

Provide deafblind people who are admitted to hospital with continuous, in-person communication and navigation support as needed.

Develop a communication passport stating individual needs – recommended particularly for emergency care.

Directed at:

policymakers
local authorities

To bring the UK into line with other countries, support must be universal and not means-tested. Deafblind people are often forgotten in disability policy and have long been left behind in society and the workforce.

DHSC to immediately review joint health and social care provision for deafblind people.

Make deafblind people eligible for one-to-one support packages solely because they are deafblind and irrespective of current social care eligibility, to meet their communication and service navigation needs.

Consider alternative schemes for supporting deafblind people and particularly those of working-age.

Clarify and make applicable existing continuing healthcare (CHC) criteria to deafblind applicants. CHC enables access to a package of ongoing care which is designed to meet physical or mental health needs that have arisen because of disability. This could be used by deafblind people to ensure full and non-means-tested support for all care needs, including communicator guides, where this provision is not provided by local authorities. This recommendation will be crucial if financial eligibility is not revised for universal deafblind access to social care packages.

Reintroduce sensory support teams with a dedicated expert deafblind practitioner in every local authority for more effective implementation of the Care Act 2014 in England. This includes assessment by appropriately trained teams with the knowledge of how to arrange appropriate specialist provision. Specialist deafblind and sensory team provision is also recommended in Scotland and Wales.

8. Centralised national commissioning model for delivery of specialist deafblind services

Directed at:

commissioners
local authorities
deaf and deafblind organisations

A centralised model for the delivery of specialist deafblind services within each nation (England, Scotland and Wales) avoids disjointed provision at a local level. It also recognises the level of specialism involved and the challenge of delivering across a geographically spread BSL-using population.

Services should be delivered with deafblind organisations, from which local authorities and those using direct payments could commission or purchase services. This would enable all deafblind people to receive specialist provision and rehabilitation, and in England, meet the social care needs identified following a specialist deafblind Care Act assessment. This would include an assessment from qualified assessors, rehabilitation, and provision to meet identified needs and prevent escalation of unmet health and social care needs. Organisations should be supported to build skilled workforce capacity.

Buy specialist services for deafblind assessment, rehabilitation and provision, where there is insufficient expertise within local authorities, even if these services are out of area or more expensive.

9. Centrally commissioned national centres of excellence for deafblind (re)habilitation

Directed at:

commissioners
local authorities
organisations for deaf, deafblind and blind people

Include deafblind people at every level of service planning and delivery of specialist services, through consultation, leadership and employment.

Tailor services specifically for the needs of deafblind people. Partnerships between specialist services and charity providers like Guide Dogs for the Blind Association are recommended to develop rehabilitation and mobility training expertise for deafblind people.

Increase deafblind access to rehabilitation and training to learn appropriate languages, communication methods and skills, including BSL, tactile BSL, braille and mobility and orientation. Instruction must be available using BSL rather than the use of an interpreter or intermediary.

Increase provision of group courses and residential rehabilitation as a cost-effective mode of delivery suitable for many people and to build deafblind community networks – reducing loneliness and isolation.

Collaboration between national centres of deafblind excellence and local authority vision rehabilitation services, tailored to individual needs and life goals, to ensure good development and transfer of rehabilitation learning within a person’s local and home environment.

10. Psychological and mental health support for deafblind people who use BSL

Directed at:

commissioners
specialist BSL mental health services
organisations for deaf, deafblind and blind people

Deafblind people can become intensely isolated in unsuitable mental health provision where there is poor awareness of their basic needs, causing severe communication and sensory deprivation. Deafblind people need mental health support and psychological therapy from services that understand their needs and challenges.

Qualified clinical practitioners must provide this within:

NHS commissioned mental healthcare for BSL users
existing and new mental health services for deaf people must be additionally commissioned to provide specialist mental health support for deafblind BSL users, including those who use tactile BSL
deafblind specialist habilitation services, which do not yet exist

11. Residential care

Directed at:

policymakers
local authorities
healthcare boards

There is currently only one dedicated residential service in the UK for older deaf BSL users. Healthcare boards and local authorities must work together to commission new regional options for residential care, respite care and in-home or community care, with nursing support suitable for deafblind people. Once organisations are developed, local authorities, the NHS and self-funders can purchase their services.

Develop a national strategy to significantly increase specialist BSL residential care homes, day care, and in-home support for older deaf and deafblind people to meet urgent needs.

Deal with the very real isolation that deafblind people face because of a lack of communication and sensory support by investing in community support services to prevent them needing hospital or residential care.

Reduce the long delays in finding suitable care for deafblind individuals moving from hospital to residential care settings.

Recruit specialist social workers and increase training to appropriately assess and understand the specific needs of the deafblind population.

12. Safeguarding and complaints

Directed at:

commissioners
local authorities
deafblind organisations
NRCPD

Deafblind people need accessible ways of raising complaints, and concerns about safeguarding and professional regulation. This is best achieved for deafblind BSL users through the recommended nationally commissioned BSL complaints service, which must include mechanisms to complain using tactile BSL with face-to-face appointments.

Commission tactile BSL support for deafblind complainants, so they can request a home visit from a trained complaints facilitator who has tactile BSL and visual-frame signing skills and can meet them in person.

Ensure complaint requests can be made independently, via braille or screen-readers, text, email or through a trusted party to arrange the home visit.

Make sure statutory care assessors and all public services follow their duty to explain a deafblind person’s rights to make a complaint and how to do so.

Ensure community outreach events for deafblind BSL users to educate people about their right to complain and how to do this.

13. Building workforce capacity

Directed at:

DfE
local authorities
universities, education and qualification bodies
NRPCD
Signature

The shortage of BSL interpreters with the requisite skills and qualifications to work with deafblind people must urgently be addressed.

Relevant awarding and registration bodies should clarify current pathways to qualification and registration (including a clear framework for the route to registration for those with legacy qualifications) and create a plan for how barriers may be removed.

Relevant awarding and registration bodies should consider adding modules on deafblind communication and interpreting to existing qualification pathways for BSL-English interpreters to increase the number of interpreters with competency in working with deafblind people.

Regulate communicator guides as a profession, with a clear qualification pathway, a register, safeguarding Disclosure and Barring Service checks and pay that reflects their unique skill set.^{[footnote 28]}

Avoid worsening the current communicator-guide workforce shortage by allowing a transitional period for qualification and registration.

Create professional boundaries and appropriate behaviour training for communicator guides as an urgent priority.

Address the shortage of multi-sensory impairment (MSI) teachers and intervenors.

Offer government bursaries for those training as deafblind interpreters, communicator guides, MSI teachers and intervenors, and specialist (re)habilitation workers to rapidly build capacity and address the skills shortage.

Work with universities, education and qualification bodies to provide rapid scaling of training courses and ensure consistent quality.

Develop a skilled workforce to support deafblind people, recruitment and retention issues must be addressed through higher rates of pay in recognition of the specialist level of the competency, professional status and additional skills, and length of training of deafblind interpreters, communicator guides, support workers , rehabilitation workers and intervenors.

Implement higher rates of pay for deafblind support professionals within local authorities and NHS agencies, to reflect the higher levels of skill required and improve retention of skilled workers. The full implementation of legal frameworks that mandate this is necessary where they are in place, specifically in England.

14. Identifying Deafblind and Deaf BSL communities as a crucial labour resource

Directed at:

DfE
local authorities
Signature
organisations for deaf, deafblind and blind people

The best way to rapidly improve things for deafblind signers is to harness the expertise and firsthand knowledge of deaf and deafblind BSL workforce. Enhancing the skills of the existing deaf workforce and focusing on their experiences to provide direct BSL services to deafblind people is the most effective and economical approach. Deafblind people must take leadership roles in teaching and training.

Remove the current qualification requirements for clear speech to encourage deaf BSL users to train as interpreters for deafblind people, communicator guides, support workers and intervenors.

Provide training bursaries for BSL users and particularly deafblind people, to become teachers and assessors of tactile and protactile BSL.

Implement leadership programmes for deafblind people and ensure their representation on organisation boards and decision-making bodies. Deaf, deafblind and blind organisations should take the lead on this.

Question 3

Conclusion

Accepted Answer

The analysis within this report confirms that the chronic access failure and exclusion experienced by deaf and deafblind BSL users are not just shortcomings but the result of systematic ableism and audism within health and social care services. This discrimination creates a deep lack of trust and causes cumulative trauma for deaf and deafblind people. These enduring failures are perpetuated by a mindset that often frames provision for deaf and disabled people as a struggle or a balancing of accounts.

We need a fundamental philosophical shift: the government must stop viewing deaf and disabled individuals as a deficit and start recognising them as contributors, innovators and a valued resource whose skills and potential are currently lost to a lifetime of health and social care struggles.

The implementation of this report’s 12 essential priorities, strategically focusing on mobilising BSL community expertise and mandating the collection of good-quality data, is the required roadmap to achieving this transformation. By executing this comprehensive strategy, the UK can move beyond inclusion as an obligation. Instead, we can uphold social justice while realising the economic benefits of reduced dependency, better health outcomes and the increased productivity of the BSL community and deaf and deafblind people.

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Areas for action

18 areas for action for service providers and health and social care professionals working with the Deaf community.

1. Research

2. Building a BSL workforce

Build BSL expertise for hearing and deaf staff.

3. Deliver consistent services to BSL users in line with the Accessible Information Standard

4. BSL interpreting

Strengthen standards and regulations through statutory registration of BSL interpreters.

5. Tenders, contracts and service-level agreements for BSL interpretation

Contracted agencies must have clear standards for quality control, monitoring and accountability to end the problem of inconsistent quality of BSL interpreting provision.

Service-level agreements

6. Care inspectorates

Care inspectorates in each nation should implement training on the needs of deaf and deafblind people and BSL users. Inspectors must understand what a good model of BSL provision and accessibility looks like.

7. Accessible estates

Health and social care estates and buildings that people visit to receive care or support need to be accessible and designed for deaf and deafblind users.

8. Accessible BSL information

NHS

Social care

Additional actions

9. Health prevention and promotion

A targeted approach is required to build stronger relationships with Deaf communities, including minority groups, through outreach, engagement and targeted healthcare workshops.

10. Audiology and vision services

These services are a priority for improvement, with high numbers of deaf and deafblind users.

11. Long-term conditions

Specialist support services should be established for deaf people with long-term conditions and multiple comorbidities (more than one disease or health condition).

12. Neurological and neurodevelopmental conditions

13. Mental health

Commissioners must develop national strategies with named strategic or policy leads for the delivery of targeted BSL mental health services.

14. Advocacy services

Improve access to BSL-proficient advocacy services and health navigators to support deaf people in accessing their rights to equitable service provision.

15. Social care

Implement a clear and accessible registration and reporting process within social care services to specifically identify BSL users, deaf and deafblind individuals and generate data to accurately track the needs of our populations.

16. Support for children and families

Prioritise preventative and supportive social work input for families of newly diagnosed deaf children, delivered in partnership with sensory teams and specialist social workers in line with section 17 of the Children Act 1989.

17. Private health and not-for-profit social care providers

18. Registration of births and deaths

Introduce remote BSL Video Relay Interpreting (VRI) to every Register Office.

Urgent improvements for deafblind people

14 urgent improvements to address the crisis in provision for deafblind adults and children, to increase access to health and social care services, and support their active participation in society.

1. Definition

2. Consistent provision

3. Data

4. Research

Funding for health and social care research is hampered by grant criteria that favour studies with an impact on large populations. It is difficult to get funding for small, geographically dispersed populations such as the deafblind population of 450,000, and the smaller population who use BSL.

5. Deafblind children

Expert sign language users must be involved at every stage of the care pathway so that all deafblind children, including those who use BSL and its tactile forms, can meet their potential as learners, community members and citizens.

6. Consistently applying Accessible Information Standards for deafblind people

7. Improving social care provision

To bring the UK into line with other countries, support must be universal and not means-tested. Deafblind people are often forgotten in disability policy and have long been left behind in society and the workforce.

8. Centralised national commissioning model for delivery of specialist deafblind services

9. Centrally commissioned national centres of excellence for deafblind (re)habilitation

10. Psychological and mental health support for deafblind people who use BSL

11. Residential care

12. Safeguarding and complaints

13. Building workforce capacity

The shortage of BSL interpreters with the requisite skills and qualifications to work with deafblind people must urgently be addressed.

14. Identifying Deafblind and Deaf BSL communities as a crucial labour resource

Conclusion

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