Independent report

Acknowledgements and annexes (BSL and English versions)

Published 27 November 2025

Acknowledgements 

https://www.youtube.com/watch?v=NHRL58CFB9k

The BSL Advisory Board extends our sincere thanks to all the organisations, networks, community groups and experts who contributed their time, knowledge and insights to this report. There were more than 120 contributors to this review. The majority were deaf or deafblind BSL users who are experts within their organisation or field. A special thanks goes to Dr Joanna Atkinson for her expertise as the report author. We are also grateful for the guidance and support of Professors Jemina Napier, Bencie Woll, Alys Young and Dr Peter Simcock, who assisted with revisions and provided invaluable expertise, and to Abigail Gorman who provided detailed revisions and knowledge about policy frameworks. 

Annex A: Contributors

https://www.youtube.com/watch?v=NZ-peUzpS2M

Expert reference group 

Organisations 

• Action Deafness 
• Association of Sign Language Interpreters
• British Deaf Association 
• Deaf Action 
• deafPLUS 
• Deafblind Scotland 
• Deafblind UK 
• Jewish Deaf Association
• National Deaf Children’s Society
• Royal Association for Deaf People
• Royal National Institute for Deaf People
• Scottish Government Equality Unit for Scotland BSL Act
• Sense
• SignHealth

University research centres

Birmingham City University, Deafblind UK Centre for Education and Research

• Dr Peter Simcock

Heriot-Watt University, Signs@HWU

• Professor Jemina Napier
• Professor Annelies Kusters
• Dr Robert Adam

Swansea University, Tackling Deaf Health Inequalities Research Centre

• Dr Julia Terry

University College London, Deafness, Cognition and Language Research Centre 

• Professor Kearsy Cormier
• Professor Bencie Woll 

University of Manchester, Social Research with Deaf People 

• Professor Alys Young 
• Dr Emma Ferguson-Coleman
• Dr Rosemary Oram
• Dr Katie Rogers

Professional network groups

Applied Psychology and Deafness Special Interest Group 

• Dr Ben Holmes, Dr Sarah Powell

BSL Alliance – Early Years Group

• Martine Monksfield, Lesley Reeves Costi 

British Society of Mental Health and Deaf People 

• Dr Kevin Baker, Dr Katie Rogers

Deaf BSL Nurses’ Forum

• Jackie Wan

All Wales Deaf Mental Health and Wellbeing group 

• Dr Anouschka Foltz
• Dr Sara Rhys-Jones
• Paul Redfern
• Dr Christopher Shank
• Dr Julia Terry
• Dr Rob Wilks

Deaf Social Workers Group

• Sharon Hirshman
• Sabina Iqbal
• Caroline Mullins
• Isabel Reid

Interpreters of Colour Network 

• Nana Yaa Danso
• Tayo Igbintade
• Ali Gordon
• Layne Whittaker

Local Authority Workers Disability Interest Group – network for social services practitioners working with deafblind people

• Jo Brady
• Hazel Lacy
• Tracey Osborne
• Bernadette Wakeling

National Deaf and Hard of Hearing NHS Staff Network

• Matthew James 

Social Workers Hearing Loss Professional Network

• Bernadette Wakeling

Speech and Language Therapy Involving BSL and Deaf People 

• Joanna Hoskin, Lenka Novakova, Ellen Swann

Community network groups

Black Deaf UK 

• Kevin Buckle
• Barbara Burke
• David Ellington
• Maresia Liburd-Spencer

Children of Deaf Parents UK 

• Jasveen Kaur

Coda UK & Ireland 

• Jemina Edwards

Deaf Ethnic Women’s Association 

• Rubbena Aurangzeb-Tariq

Deaf Rainbow 

• Tammy Broskom
• Dr Tyron Woolfe

Deaf UK 50 Plus

• Joseph Collins
• Roger Beeson

Deaf Parenting UK 

• Jasveen Kaur

Service providers and initiatives

Avon and Wiltshire Mental Health Partnership NHS Trust – specialist Deaf service, joint assessment pathways

• Dr Mary Griggs

Falcon Road (Wandsworth) BSL Sexual Health Service

• Dr Rose Balázs 

Glasgow City Health and Social Care Partnership

• Afton Hill
• Paul Hull

Islington Council Sign Language Interpreting Services 

• Debbie Conway
• Nikki Freeling

Macmillan Deaf Cancer Support Project

• Claire Adshead
• Niki Johnson

National Deaf Adult Mental Health Services (England)

• Dr Alex Hamilton
• Lenka Novakova

National Deaf Child and Adolescent Mental Health Service (England)

• Rachael Hayes
• Dr Sophie Roberts

National Hospital for Neurology and Neurosurgery – Cognitive Disorders Clinic for deaf patients

• Dr Joanna Atkinson
• Katy Judd
• Professor Cath Mummery

Northumbria Healthcare NHS Foundation Trust – Deaflink BSL health navigator project

• Heidi Jobling

SignHealth Psychological Therapy Service – National Talking Therapies Service for Deaf People and Improving Access to Psychological Therapies

• Dr Sarah Powell

NHS Lothian – Scottish Mental Health Service for Deaf People

• Dr Deborah Innes

Individual experts

• Emma Boswell, Deafblind community expert 
• Damien Brewer, Public health 
• Alison Bryan, Deaf carer 
• Dr Jordon Fenlon, Epidemiologist and health statistician 
• Dr Celia Hulme, Postdoctoral researcher on improving audiology services 
• Paul Kirby, Care inspection and quality monitoring
• Meghan Luton, Midwife and PhD researcher on maternity care for deaf women
• Rachel Noar, Hospital governor
• Morgan Phillips, Complaints investigator
• Sarah Reed, Deafblind community expert
• Christopher Reid, Commissioner 
• Dr Natasha Wilcock, Palliative care doctor 
• Dr Tyron Woolfe, London Deaf Migrants Project 

BSL Advisory Board 

Co-Chairs

• Craig Rowley MBE
• Alexandra Gowlland

Chair of Subgroup on Health and Social care 

• Dr Joanna Atkinson 

Board members

• Zoe Fudge-Ajadi
• Vicki Ashmore
• Teri Devine
• Catherine Drew
• Abigail Gorman
• Gaye Hampton 
• Asif Iqbal
• Erin McCluskey
• Richard MacQueen
• Ahmed Mudawi
• Richard Platt
• Kate Reed
• Sylvia Simmonds
• Samantha Stocken
• Mangayarkkarasy Sutharsan
• Martin Thacker

Annex B: Reviews affecting deaf and deafblind people

https://www.youtube.com/watch?v=mWCEssW7yKM

The following reviews have made recommendations for the deaf and deafblind community, but these have not been fully implemented.

England

2025

SignHealth, ‘Still ignored: the fight for accessible healthcare’, 2025. Published on SIGNHEALTH.ORG.UK.

2024 

Evidence submitted to the COVID-19 Inquiry.

Written evidence submitted by SignHealth (MRS0215), Published on COMMITTEES.PARLIAMENT.UK.

Witness statement of Dr Sarah Powell, 2024. 

“I mean 4 years later… My husband went to hospital recently and stayed for 6 days and there was still no interpreter. Absolutely, nothing has changed.” 

Module 3 Week 6, Dr Sarah Powell. 

2023 

SignHealth, ‘Shaping the future of deaf mental health’, 2022. Published on SIGNHEALTH.ORG.UK.

2022 

SignHealth, ‘Review of the NHS Accessible Information Standard’, Published on SIGNHEALTH.ORG.UK.

2021 

This is NHS-commissioned research that has already identified the issues and outlined clear solutions for commissioners but no action has been taken. 

UK Council on Deafness, ‘Report to NHS England on the outcome of a rapid review of commissioning arrangements for British sign language interpreting services’, 2021. Published on UKCOD.ORG.

2018 

Guidance for commissioners of interpreting and translation services in primary care. 

NHS England, ‘Guidance for commissioners: interpreting and translation services in primary care’, 2018. Published on ENGLAND.NHS.UK.

2017 

Guidance for commissioners of primary care mental health services for deaf people.

Joint Commissioning Panel for Mental Health, ‘Guidance for commissioners of primary care mental health services for deaf people’, 2017. Published on SIGNHEALTH.ORG.UK.

Scotland

2023 

BSL National Plan 

Scottish Government, ‘British Sign Language (BSL): national plan 2023 to 2029’. Published on GOV.SCOT.

2022 

The National Audiology review 

The Health and Social Care Alliance Scotland (the ALLIANCE), ‘’, 2023. Published on ALLIANCE-SCOTLAND.ORG.UK.

2019 

The Landscape Review commissioned by the Scottish Government to provide detailed information about BSL/English interpreting in Scotland to inform policy decisions around the implementation of the British Sign Language (Scotland) Act 2015 and the BSL National Plan 2017 to 2023. 

The Landscape Review/Queen Margaret University, ‘British sign language interpreting in Scotland: a landscape review’, 2019. Published on BSLSCOTLANDACT2015.SCOT.

2014 

See Hear – a strategic framework for meeting the needs of people with a sensory impairment in Scotland. 

Scottish Government, ‘See hear’, 2014. Published on GOV.SCOT.

Wales

2025 

Royal National Institute for Deaf People, ‘Still ignored: the fight for accessible healthcare (Wales)’, 2025. Published on RNID.ORG.UK.

2022 

Response to Senedd Cymru, Welsh Parliament 

Mental health inequalities consultation from the All Wales Deaf Mental Health and Well-being Group.

Senedd Cymru (Welsh Parliament)

2021 

All Wales Deaf Mental Health and Well-being Group, ‘Deaf people Wales: hidden inequality’, 2021. Published on SWANSEA.AC.UK.

Annex C: Services and situations that exclude BSL users

https://www.youtube.com/watch?v=Bc8k5s2xQmY

Lack of interpreting provision means that BSL users are excluded from many situations and services in their daily lives. 

Life events

• Ceremonies (for example, graduation, baptism, weddings)
• Communicating with family members who do not know BSL
• Family events
• Funerals and making funeral arrangements engaging with undertakers 

Healthcare 

• Access to NHS health promotion, events or courses
• Dentist
• Opticians
• Chiropodists
• Drugs or alcohol support groups
• Making a GP or NHS healthcare appointment
• Pharmacy first consultations at local chemists
• Private counselling or psychological therapy
• Private healthcare providers
• Private stopping smoking
• Private therapists – physiotherapist, acupuncture, chiropractor, reflexologist, nutritionists. 
• Private weight-loss classes
• Self-help therapy groups
• Support groups (for example, antenatal and postnatal, breastfeeding support, diabetes, and living with healthcare conditions such as dementia, stroke, aphasia) 

Carers

• Attending healthcare appointments with others
• Carer support groups
• Communication for managing a loved one’s affairs or their healthcare

Parenting 

• Antenatal and postnatal support groups 
• Baby and toddler groups
• Classes and activities for pre-schoolers (for example, swimming) 
• Library story telling 
• Parent Teacher Association (often known by the shorthand PTA)
• Parent’s evening – interpreters are not always provided by schools
• Parenting groups and classes for parents 
• School events such as Christmas concert, sports days. 
• School governor
• School and nursery visits when applying for a place

Deaf children and young people

• Access to clubs and activities 
• After-school clubs
• Play schemes 
• Pre-school 
• Work experience placements 

Leisure

• Art galleries
• Charity fundraising events
• Group tours 
• Hobby clubs (cooking, crafts, sports, book clubs, special interests)
• Holidays
• Social events and groups
• Theatre

Sports and exercise

• Exercise classes
• Gym sessions 
• Running clubs
• Park run briefings
• Personal trainers
• Sports tuition, training and teams 

Spiritual

• Pastoral care and guidance
• Spiritual education courses
• Religious services and ceremonies

Adult education 

• Adult literacy classes
• Evening classes
• First aid training
• Further education (FE) college courses for adults (including those changing career) – sometimes communication support workers are provided but these are not sufficiently fluent in BSL to provide full access
• Workshops

Life admin 

• Advice before making large purchases (cars, furniture, computers, electronics)
• Banking
• Broadband network providers
• Builders and tradespeople 
• Estate agents 
• Financial advisors and pensions 
• Insurance
• Mortgage advisors
• Phone or video calls to hearing people and service providers (lack of VRS service in England and Wales)
• Remote language support or advocacy
• Translating letters or documents 
• Utility providers (for example, electricity, mobile or telephone)

Older adults 

• Attending day care centres
• Communicating with care providers
• Home care 
• Nursing homes 
• Respite care

Legal

• Consultations about home buying/ building
• Contract agreements
• Making a will 
• Mediation services
• Solicitors
• Sorting power of attorney

Local community

• Campaign meetings or events
• Events and talks
• Fairs and fetes 
• Joining board of governors
• LGBT+ groups or meetings 
• Neighbourhood network meetings 
• Neighbourhood Watch
• Parish and council meetings 
• Political groups and parties
• Theatre and outdoor performances
• Volunteering

Work

There are some circumstances for which Access to Work (AtW) interpreter provision is not currently sufficient. 

• Self-employed people cannot access BSL interpreters for the first year after setting up a business or going freelance – the rule about this needs to be changed. 
• Deaf people in communication intensive jobs are currently impacted by the AtW cap.
• Unqualified interpreters are often used at Job Centre+. 

Volunteer work and internships

• AtW budgets are not available for volunteer work
• Deaf BSL users are excluded from volunteering as no BSL interpreters are available
• No AtW for internships and work experience 
• No AtW funding for unpaid college or university work placements (Disabled Students’ Allowance may be insufficient)

Education 

Where a deaf child has provision through an education, health and care plan, unqualified interpreters such as communication support workers are often used in:

• colleges – adult education, FE 
• mature students aged over 25 years in FE   
• nurseries
• schools

Prison

• Deaf inmates often do not have access to interpreters and cannot take part in rehabilitative courses. 
• Need to provide video remote interpreting and video relay services 

Annex D: Case studies, lived experiences and good practice

https://www.youtube.com/watch?v=a4LnP6ms-1g

Deafblind case studies

Adam, age 69 years, was born deaf and was later diagnosed with Usher syndrome, type 1. This led to his sight deteriorating in early adulthood and he now has a very small amount of tunnel vision in one eye only.

Deafblind UK, ‘Adam’s story’, 2024. Published on DEAFBLIND.ORG.UK.

Natalie, age 56 years, is a strong and confident lady who loves walking, swimming and cycling. She has a great sense of humour and loves to socialise. Natalie was born deaf and her first language is BSL. In her 40s, she developed glaucoma which sadly left her with no useful vision. Ever resilient, Natalie quickly learned a tactile adaptation of BSL, known as ‘hands on BSL’.

Deafblind UK, ‘Natalie’s story’, 2024. Published on DEAFBLIND.ORG.UK.

Lived experiences of deaf and deafblind people featured in Locked Out

Communication barriers

Welsh BSL user – interpreter struggles with Welsh address:

Interpreters do not easily recognise my address, it is all in Welsh and often they do not know where Powys is and sometimes are unable to recognise this as a county. They have to identify which region of the UK I am in to make a call. I always type my address, as interpreters aren’t able to get the fingerspelling or pronounce it, as they are from outside Wales. They usually say it using the phonetic alphabet.

Deafblind person – booking and access difficulties:

It is almost impossible to get a tactile interpreter. Sometimes a regular interpreter will turn up and then they will leave when they see I need hands-on [support]. It’s also hard to arrange a communicator guide to get me to the doctor in the first place. I can’t book my own appointments because the receptionist insists I must use the e-consult system. I’m stuck because I can’t see the screen and I can’t use the phone. Deafblind people must try not to be ill.

Deafblind NHS inpatient – hospital trauma:

I didn’t know who was around me. They just kept grabbing me. They didn’t know how to tell me what was going on. It was terrifying!

Deaf BSL user – lack of communication and control causing trauma:

They were pinning me down on the bed and I didn’t understand why. I was in pain and so dizzy. I couldn’t tell them I was going to be sick. I was trying to tell her but they couldn’t understand my speech. Because the nurse didn’t act quickly, I threw up all over the bed then saw her rush for a bowl. My mental health really suffered for a long time.

Deaf BSL user – avoiding care due to communication barriers:

I avoid seeking medical care because of the communication barriers. From the point of being ill, to getting better, it is a nightmare. Trying to seek advice is impossible. Booking the appointment, I have to attend, knowing the diagnosis and treatment plan is impossible for me to understand. And for any follow-up care, I wouldn’t have a clue what to do without BSL support.

Hearing parent – bad communication:

“I couldn’t really understand why (BSL) was discouraged it didn’t make any sense.” 

Emotional impact and isolation

Deaf carer – anxiety and grief:

I am experiencing high levels of anxiety from persistent access issues and these continue. It is to the point where I am now freezing with fear at this, and it is overwhelming because external barriers and people’s attitudes are outside of my control. This lack of communication I believed contributed to dad’s death too.

Deaf carer – communication breakdown:

My mum was seriously ill on the ward. I was told to phone for updates but there is no VRS service. When I said I was deaf, the hospital offered to email me, then they didn’t… It is more convenient for hospital staff to speak with my sister who is in the USA, because she can use the phone. There is a lot of additional baggage for deaf carers well beyond what other carers experience.

Deaf carer – exhaustion from advocacy:

I left the hospital stressed, upset and exhausted at having to continually raise access issues and ask for adjustments so that I could support my mum.

John Skinner – residential care loneliness:

I’m lonely. No one to talk to. I watch people laugh and talk. I have to watch and wait for my moment to ask for a drink. I can’t say to staff, ‘I’d like a little more or less in my drink’. I try to teach staff BSL but they don’t understand.

Deafblind person – COVID-19 isolation:

It was 2 whole weeks before I knew about the COVID-19 lockdown… It was a big shock to realise I was the last person to know about COVID.

Hearing adult heritage signer – lack of interpreters at critical times:

I had to suppress every emotion to be able to interpret and that affected me. Even though we knew dad was going to pass away, I don’t feel like I said goodbye to him.

Deaf BSL user – lack of interpreters causing stress:

Today I arrived at the appointment and there is no interpreter. When I arrived the staff spoke to me and I didn’t understand what they said. I could not lip-read 100% of what they were saying. They looked on the computer and said no interpreter had been booked again. I was fuming. They gave me a new date for an appointment in 2 weeks.

Parent of a deaf child – trauma from thoughtless communication:

The bottom fell out of my world, my beautiful baby was labelled as broken.

Hearing parent – positive communication:

I was incredibly lucky to have been offered both BSL Level 1 and 2 free by the wonderful sensory support service in Bromley. They also offer free Family Sign. As a parent of a child who is diagnosed with mixed bilateral hearing loss, this has been invaluable.

Deafblind person – lack of choice and support”

I was a skilled professional working for a charity but I had to give up work and go on benefits. It was the only way to get direct payments so I could get out of the house.

Deafblind person – lack of financial support to live

As of now, I’m housebound. I would go on outings or socials but it costs me over £100 each time I go out to meet friends, and often I can’t find anyone to take me.

Missed or unsafe care

Deaf BSL user – NHS 111 loop and emergency overload:

Thanks to NHS 111 VRS… I’ve even been in a stupid four-person relay chain because of this issue and they ended up sending 6 paramedics here at the same time!

Tactile BSL interpreter – delayed care and emotional toll:

One patient was told his sight could have been saved if he had been seen earlier.

NHS nurse in emergency care – poor communication and lack of control causing trauma:

She woke up and could not feel her arm or leg. There was no interpreter to explain that she had a stroke. We had no way of explaining. She was so distressed. Later, we realised that she thought we had injected her and paralysed her left side.

Deaf BSL user – lack of control causing trauma:

I asked for a female interpreter because of my past abuse experiences but they sent a man anyway. I have no control over who is going to turn up.

Deaf BSL user – lack of interpreters and appointments:

Previously, I did not enjoy going to see my GP as it was so difficult to get an appointment and no interpreters. Knowing there will be interpreters at my appointments (via a confirmation text message) has brought me such relief. I am now taking better care of my health and looking after myself, which I couldn’t do previously. Which means I now see the doctor less.

Hearing son of deaf BSL user – inaccurate diagnosis and ineffective treatment:

The problem was that the clinicians could not communicate directly with her or see beyond her deafness, so they struggled to understand the meaning of mum’s difficulties. Many were unable to see past their negative assumptions of what it meant to be a deaf person, including assuming low intelligence or that her cognitive and reading difficulties were simply caused by her deafness. Consequently, mum was given inaccurate diagnoses and ineffective treatment.

Palliative care doctor – missed critical care:

Right now, the experiences of deaf people … are shocking. I have met patients who have been referred to palliative care services who have not understood that they will no longer be receiving cancer treatment. They haven’t understood that they are dying.

Deafblind person – abusive situations:

I realised my communicator guide was slipping her own groceries among my pile of shopping at the till. It’s the cunning that is despicable. Another, male guide’s hands lingered in [the] wrong places and I could not do anything.

Barriers to understanding and decision-making

Deaf BSL user – Pharmacy First confusion:

If they write anything down, I don’t understand… I want them to make recommendations so I can make an informed choice… The solution is simple – provide a VRS app that I can use to communicate with NHS services including Pharmacy First.

Deafblind person – vision exam distress:

They refused to put lights on… I sat on a box of medical equipment and then ended up on the floor. It was so humiliating that I cried.

Deafblind person – importance of tactile guidance:

A simple thing like gently touching my face to show the direction you want me to look during an eye examination makes a huge difference to me. It makes me feel calmer and respected as a person who needs touch.

Deaf specialist intermediary – misunderstanding causing stress:

I reminded the social services before not to text or email the client because of his limited capacity in understanding English. He was sent a long text from the social worker asking why he has stopped visiting his child. He …(understood) ‘stopped’ as ‘banned’ or ‘not allowed’ so he became distressed.

Tactile BSL interpreter – lack of information causes inappropriate care:

I had no way of explaining to my deafblind client about her breast tumour surgery without touching her own breasts … Tactile models for healthcare should be made available.

Case studies 

Missed brain injury diagnosis

A deaf woman was discharged without a brain scan after a car accident due to lack of communication. She later suffered long-term consequences from an undiagnosed brain injury.

Informed consent failure

A deaf woman unknowingly agreed to leg amputation because the interpreter left mid-consent process. She woke up shocked to find her leg removed.

Isolation

• John Skinner (Daily Mail): expressed loneliness and communication deprivation in a care home.
• Deaf resident: “My communication is limited to ‘thumbs up’.”
• Deafblind NHS inpatient: “I didn’t know who was around me… It was terrifying!”
• Interpreter leaves mid-consent: a deaf woman unknowingly agreed to leg amputation.
• Missed brain injury diagnosis: a deaf woman discharged without a scan due to lack of communication.
• COVID-19 delay: a deafblind person learned about lockdown two weeks late due to lack of accessible communication.
• Deafblind patient relief: interpreter describes patients crying after repeated appointment delays due to lack of tactile BSL support.

Good practice

Mental health and advocacy

• Jewish Deaf Association: one-stop advocacy service, saving NHS £337,000 in missed appointments and improving access.
• Northumbria Healthcare’s BSL Health Navigator project: improved interpreting provision, patient experience and informed consent rates.

Deafblind-specific services

• Protactile movement (USA): development of a tactile-first sign language with emotional feedback and efficient grammar.
• Moorfields Eye Hospital (London): commissioned a deafblind specialist agency for interpreting.
• BSL health access (SignHealth): provided VRS/VRI during the pandemic, handling 30,000 calls in one year.

Social care and residential provision

• Gelderhorst Centre (Netherlands): purpose-built deafblind care facility with tactile accessibility and all staff fluent in sign language.
• Sheffield BSL café in care homes: deaf social worker initiated BSL cafés and staff training in mainstream homes to build future capacity.
• Ravenscroft residential home (Sheffield): previously offered dedicated BSL provision for 20 deaf residents.
• VRS literacy support: on-demand translation of documents via video call with qualified BSL-English translators.

Healthcare access and communication

• NHS Mersey Care: offers BSL self-help videos and accessible formats.
• NHS Inform (Scotland): centralised webpage with BSL-translated healthcare information.
• SignHealth BSL health library: 376 health videos accessed by over 31,000 people in one year.
• NHS Greater Glasgow and Clyde: QR code posters at reception desks for instant VRS access.
• Royal Devon and Exeter Hospital: QR posters above beds to request BSL interpreters or access VRS.
• Milton Keynes University Hospital: trialled VRS in emergency and maternity settings.
• Macmillan Deaf Cancer Support Project: offers tailored BSL videos, advocacy and peer support.
• Manchester hearing aid clinic: piloting a Deaf cultural-competence framework with visual calling systems, BSL resources and co-created guidance.