Independent report

Executive summary: 12 priorities and key insights (BSL and English versions)

Published 27 November 2025

https://www.youtube.com/watch?v=YFcQ8DzfHhM

The lack of access to health and social care services faced by deaf and deafblind British Sign Language (BSL) users in the UK is a decades-long challenge. Their systemic exclusion is entrenched and normalised as part of everyday life. It is much harder for them to access services that hearing people take for granted, such as contacting a GP to book an appointment, understanding treatments or knowing their name is called in a patient waiting room. 

The comprehensive Locked out report highlights the known health and social care needs of these communities, the persistent barriers they face that lead to severe health inequalities and the lack of service engagement that results in considerable economic cost and unnecessary added burden and distress for deaf and deafblind people. 

The BSL Act 2022 requires the government to produce a BSL National Plan to improve access to public services for BSL users and promote the use of BSL across society. The health and social care findings in this report are based on an ambitious scoping review conducted by the BSL Advisory Board on the current state of deaf and deafblind people’s access to services in England, Scotland and Wales.

Here are 12 essential priorities that will unlock health and social care access for BSL users, and deliver a strong return on investment – cutting missed appointments, avoidable admissions, duplicated care and easing pressure on NHS and social care budgets.

Introduction

In the UK, there are over 450,000 deafblind people (with combined hearing and sight loss) and 151,000 BSL users of whom 87,000 are deaf.^{[footnote 1][footnote 2][footnote 3]} The Locked out report outlines the barriers to access and systemic exclusion experienced by deaf and deafblind individuals trying to access public health and social care services. These include:

• inconsistent delivery of the Accessible Information Standard (AIS)
• lack of interpreters (concluding an overreliance on unqualified interpreters or family members)
• insufficient data on BSL users
• digital platforms that are inaccessible^{[footnote 4]} 

These barriers are made worse by the geographical variation of BSL users, the workforce shortage of BSL interpreters and the patchwork provision across England, Scotland and Wales.

This report outlines the consequences of these barriers, including misdiagnosis, delayed treatment, higher hospital stays, missed appointments, avoidance of services and erosion of trust in public health. These cost the taxpayer an estimated £80 million to £100 million per year, as well as escalating lifetime costs.^{[footnote 5]} 

Our recommendations support the vision of the 10-year Health Plan for England: fit for the future, to “seize the opportunities provided by new technologies, medicines, and innovations to deliver better care for all patients and better value for taxpayers”. 

Our 12 essential priorities for BSL users will bring immediate NHS and social care savings.

The Locked out research also shows that one of the most effective ways to support and understand the needs of deaf and deafblind people is by using the strengths and experiences of qualified professionals who are themselves deaf or deafblind.^{[footnote 6]} 

Within the main report, there are an additional 18 areas for action for service providers and professionals working with the Deaf community and 14 urgent improvements for deafblind individuals to enhance access to health and social care and support their participation in society.

Terminology 

This report employs a capital ‘D’ to show where the words ‘Deaf’ or ‘Deafblind’ are used specifically in a cultural sense (for example, Deaf community, Deaf culture, Deaf identity) but otherwise use a small ‘d’ (for example, deaf people, deaf population). We use the term ‘BSL user’ to describe deaf or deafblind people who use BSL as their preferred language for communication. The terms ‘BSL community’ and ‘BSL signers’ are broader because they include hearing people who can sign and those who work with BSL users, including BSL interpreters and family members. Please explore our glossary of terms on the Deaf, Deafblind and BSL community, and related policy and legislation.

About

Following the 2022 BSL Act, a non-statutory board of 17 members – primarily BSL users – was formed to advise the government on issues affecting deaf and deafblind people and to support the act’s implementation. The BSL Advisory Board explores these issues through themed subgroups. Locked out was produced by the Health and Social Care Subgroup, chaired by report author Dr Joanna Atkinson. The group consulted over 60 Deaf organisations, professionals, academics and frontline health and social care staff to better understand the community’s experiences and barriers.

Dr Joanna Atkinson

A clinical neuropsychologist, research scientist and leading advocate for deaf and deafblind health equality, Jo has over 25 years’ experience and lived insight as a deaf person and later became deafblind. A pioneer in linguistically and culturally informed psychological assessments, she developed BSL-based services to improve the diagnosis of dementia, neurological conditions, ADHD and autism. Her work champions policy and practice rooted in human rights, language and autonomy, striving for equal access to health and social care services, without compromise.

Key insights and recommendations

1. Control over interpreter bookings

Recommendation

Give BSL users greater control over interpreter bookings. BSL users should be able to make requests for interpreters and receive confirmation of interpreter bookings through a dedicated app or website (for example, the NHS App).

Evidence

95% of BSL users report high stress levels during health interactions, primarily due to uncertainty about BSL interpreter availability. The Jewish Deaf Association (JDA) provided support with accessing health information in BSL on 2,246 occasions, which saved the NHS up to £337,000 on missed appointments and interpreting costs.^{[footnote 7]} Allowing users to book and confirm interpreter requests would significantly ease access anxiety and ensure appropriate communication supports are in place.

Lived experience

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.

2. Implement the Accessible Information Standard (AIS)

Recommendation

Promote Section 95 of the 2022 Health and Care Act to strengthen enforcement of the AIS. The AIS must be implemented by public, private and not-for-profit providers across all health and social care settings. 

Evidence

Research indicates that 67% of deaf people report having no accessible method to contact their GP. This highlights the urgent need for standardised communication protocols. This would ensure compliance with the Equality Act and improve overall service access.^{[footnote 8]}

Lived experience

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.

3. Establish national Video Relay Service^{[footnote 9]}

Recommendation

Establish a national video relay service (VRS) for England and Wales similar to Scotland’s, with access 24 hours a day, 7 days a week.

Evidence

Scotland’s VRS has shown improved access to services for deaf people, taking 3,000 to 4,000 calls per month.^{[footnote 10]} Cost savings can come from better use of technology, which improves the efficiency of the booking process, saves staff time and reduces cancellations and missed appointments. This recommendation would provide immediate support in emergencies and facilitate communication with various services across the UK.

Lived experience

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.

4. Digital accessibility for BSL users

Recommendation

Ensure digital accessibility of NHS and social care platforms and technologies for BSL users. The needs of BSL users must be outlined in the government’s digital inclusion strategy and included in commissioning and contracts, and deaf and deafblind people must be involved in the design of solutions. This includes QR codes linking to VRS translation, compatibility with braille readers, and onsite support for video interpretation. High-speed wifi access across all NHS and local authority estates is essential for smooth VRS access.

Evidence

Digital services often lack BSL integration, making access harder for BSL users. 89% of GP e-consultations were found to be inaccessible to BSL users.^{[footnote 11]} Ensuring digital tools account for these needs is vital for improved health outcomes.

Lived experience

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.

5. Data collection on BSL users

Recommendation

Make it compulsory for providers to collect data on BSL as a primary language and disability status, and store it centrally. This will improve health research, ultimately resulting in better health and social care outcomes.

Evidence

The absence of specific data on BSL users prevents effective service planning and resource allocation, contributing to ongoing inequalities within healthcare systems. Deaf people highlighted in one service that their BSL needs are not communicated to other services due to a lack of centralised data storage.

Lived experience

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 had stopped visiting his child. He (understood) ‘stopped’ as ‘banned’ or ‘not allowed’ so he became distressed.

6. Accessible complaint services

Recommendation

Establish a BSL complaint service within each nation, which is run by a health or social care-affiliated Deaf organisation.

Evidence

Currently, BSL users lack accessible complaint mechanisms, leaving them vulnerable to poor service experiences. This service would collect data to highlight systemic issues, identify patterns and provide a constructive feedback loop for service improvement.

Lived experience

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.

7. Mandatory training for health and social care staff

Recommendation

Implement mandatory Deaf and Deafblind culture, communication and BSL awareness training for all health and social care staff.

Evidence

Poor staff awareness of Deaf and Deafblind culture and communication can lead to inadequate care. Without training, frontline professionals cannot effectively communicate with BSL users, leading to misdiagnoses and inadequate support.

Lived experience

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.

8. Evidence-based guidelines for interpreter provision

Recommendation

Improve the quality of BSL interpreter provision by publishing statutory guidelines. Guidance must state that NRCPD-registered qualified BSL interpreters must always be provided.^{[footnote 12]} Family members must not be used to translate, and children should never be used to interpret.

Evidence

Many services fail to provide registered interpreters, leading to concerns about confidentiality and care accuracy. Family members should never be used as interpreters, particularly in sensitive situations such as personal hygiene or mental healthcare.

Lived experience

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.

9. Community-based BSL resources

Recommendation

Commissioners to prioritise the BSL community as a resource within contracts, to provide community-based interpreter agencies and to increase the provision of health, social work and social care services in BSL. 

Evidence

Working with the BSL community would enhance understanding of cultural and linguistic needs, improving service delivery and access to care.

Lived experience

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.

10. Strengthen specialist social care for deaf and deafblind individuals

Recommendation

Reintroduce and strengthen the role of specialist social workers and sensory teams for deaf and deafblind adults and children within each local authority.

Evidence

The closure of specialist services has led to inadequate assessments and resource allocation for BSL users. Specialist knowledge is essential for effective care delivery.

Lived experience

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.

11. BSL early-years support and training

Recommendation

Address language deprivation in deaf children and adults through routine early and comprehensive BSL provision and support, including free teaching of BSL for families. 

Evidence

Language deprivation has a significant effect on cognitive development. Early intervention with free BSL courses for families can reduce long-term negative outcomes.

Lived experience

I was incredibly lucky to have been offered both BSL Level 1 and 2 for 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.

12. Increase residential care options 

Recommendation

Develop a national strategy within each UK nation to significantly increase the number of specialist BSL residential care homes, day care centres and BSL in-home support. This should meet the urgent need for care provision for deaf and deafblind people of all ages, and particularly older or highly vulnerable deafblind people.

Evidence

The UK has only 2 residential homes that cater specifically to BSL users. Increased provision is necessary to support an ageing deaf population and prevent sensory deprivation and isolation.

Lived experience

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.

Conclusion

These urgent calls to action highlight the need for structural changes to healthcare and social services for deaf and deafblind BSL users. Our recommendations would lead to significant improvements in accessibility, patient satisfaction, overall health outcomes and benefits to the workforce, while reducing the state costs incurred from ongoing inequalities and unmet needs.

Find out more

Read the full Locked out report.  

There is also a comprehensive glossary of terms related to the Deaf, Deafblind and BSL community as well as policy and legislation, case studies and best practice project work currently taking place in the health and social care sector in the UK.

Find out more about the work of the BSL Advisory Board and the Disability Unit.

Acknowledgments

The BSL Advisory Board extends its sincere thanks to all the organisations, networks, community groups and experts who contributed their time, knowledge and insights to this report. Locked out was commissioned, researched and written by the Health and Social Care subgroup. We consulted over 60 Deaf organisations, professionals, including frontline health and social care staff, and academics to better understand the barriers faced by the Deaf community in relation to their experience of health and social care services. There were more than 120 contributors over the last 3 years. The majority were deaf or deafblind BSL users who are experts within their organisation or field and the wider BSL community with lived experiences of these entrenched challenges and barriers.

We are grateful for the report authorship of Dr Joanna Atkinson, and the guidance and support of Professors Jemina Napier, Bencie Woll, Alys Young and Dr Peter Simcock, who assisted with revisions and provided invaluable expertise. Abigail Gorman provided detailed revisions and knowledge about policy frameworks. We also acknowledge the editorial and support team in the UK government’s Disability Unit and freelance copyeditor and writer Jo Johnston.

1. Royal National Institute for Deaf People, ‘Facts and statements on employment’. Published on RNID.ORG.UK. ↩

2. BSL STATISTICS, ‘How many people use BSL in the UK? How many of these users are Deaf?’, 2016. Published on BDA.ORG.UK. ↩

3. Sense, ‘Deafblindness statistics in the UK’. Published on SENSE.ORG.UK. ↩

4. In England, the AIS came into force in 2016, under section 250 of the Health and Social Care Act 2012. It requires publicly funded health and social care organisations to identify, record, flag, share and meet the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss. There is currently no equivalent legal standard in other UK nations. The AIS was welcomed by deaf and deafblind organisations. It gave the legal right to receive access to health and social care information and communication in a way that works for individual needs.  ↩

5. SignHealth, ‘Where is our access to the NHS?’. Published on SIGNHEALTH.ORG.UK. ↩

6. NHS England, ‘NHS Long-Term Workforce Plan’, 2023. Published on ENGLAND.NHS.UK. ↩

7. For more information about JDA, please see page 44 of the main Locked out report.  ↩

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

9. A video relay service (also known as a video interpreting service) supports BSL users to communicate with hearing people through a video sign-language interpreter. ↩

10. Contact Scotland BSL, ‘National BSL video interpreting relay service’. Published on CONTACTSCOTLAND-BSL.ORG. ↩

11. SignHealth, ‘Results from our 2nd pulse survey of the impacts of the pandemic on the Deaf community’, 2021. Published on SIGNHEALTH.ORG.UK. ↩

12. NRCPD stands for National Registers of Communication Professionals working with deaf and deafblind People. “The NRCPD is the national regulator of over 1,600 language service professionals including BSL/English interpreters and translators, lipspeakers, notetakers, speech-to-text reporters and interpreters for deafblind people.” Published on NRCPD.ORG.UK. ↩