Deaf NHS patient case report highlights communication failures

A case report published in the online journal BMJ Case Reports details the hospital experience of a deaf man whose primary means of communication was British Sign Language (BSL). The authors, who note that the issues described are well known to deaf people using National Health Service (NHS) services, argue that the case illustrates a pressing need for institutional change in the care of deaf patients. The report highlights that reasonable adjustments required by UK disability legislation were not made during the patient’s stay, and the need for a professional BSL interpreter was not recognized soon enough. Frontline staff were also found to be inadequately trained in how to support the patient, leading to significant communication barriers throughout his admission.

The patient, who used BSL as his primary means of communication, was admitted to a frailty assessment unit. His medical notes, however, referred only to an ability to lip read if someone spoke slowly and clearly, a description that did not reflect his actual communication needs. After three days on the unit, staff deemed him well enough to be discharged home, believing he possessed an appropriate package of care. This decision was based on the assumption that he could lip read what staff were saying and had agreed to most of the questions they asked him.

The proposed discharge plan was halted when a doctor with basic BSL skills reviewed the case. The doctor uncovered that the patient’s package of care was not adequate and that he had no family nearby to support him. Consequently, the man was not discharged home on the initially proposed date. The report authors emphasize that had the patient been discharged on day three, it would have potentially risked an unsafe discharge, as the lack of an interpreter had already led to ineffective communication regarding his history and proposed care plans.

It was not until four days after admission that a professional interpreter was requested. In the interim, the hospital sourced the Interpreter on Wheels service, a portable iPad device that allows video calls with a BSL interpreter, from the outpatient department for use in future consultations. However, this service was only accessible during normal working hours. Furthermore, an unstable internet connection and the patient’s poor eyesight hampered its effective use, leaving the patient without reliable access to his primary language during critical periods of his stay.

During his hospital stay, the man developed an irregular and fast heart beat, identified as fast atrial fibrillation, and required intravenous antibiotics for a chest infection. These conditions were diagnosed clinically from blood tests and without formal communication with the patient. The report notes that he also received various other treatments, including medicine to ward off deep vein thrombosis and a blood transfusion. For such treatments, fully informed consent is required, yet a professional BSL interpreter only arrived 11 days after he had been admitted, raising concerns about the validity of the consent process.

A review of the man’s recent clinic correspondence revealed that he required a BSL interpreter for all medical consultations. The documents also indicated that he struggled to read English, had poor eyesight, and suffered from bilateral tremor, which made reading and writing difficult for him. Despite this, staff had persistently tried to communicate with him using written materials. The report authors point out that patient-centred care relies on effective communication with the patient or relatives, and this cannot be done in a language which is not their own.

Through the auspices of a BSL interpreter, the patient explained that he felt treated differently as a deaf patient, largely because everything took more effort and extra steps. Reflecting on his hospital stay, he stated that he did not understand a lot of the things that were happening to him due to staff not being able to communicate with him. He did not fully know why he was initially admitted to hospital or what he was being treated for during his stay. He was moved between different areas of the hospital without being told why or where he was going.

The patient concluded that BSL teaching to staff would be useful for simple interactions when an interpreter is not available, as it is easier to communicate with an interpreter who understands all the signs. However, he emphasized that more deaf awareness teaching is needed for staff to help other deaf patients in the future. The report authors agree, highlighting a systemic gap in training for medical staff. They argue that the lack of an interpreter led to ineffective communication, as the patient’s own language was not used to take a history or explain proposed plans.

Although this case report describes just one individual, the authors cite previous reports and research indicating that this patient’s experience of NHS healthcare is far from unique. In 2023, The British Deaf Association condemned the life-threatening communication failures faced every day by deaf people in the NHS. The association called for mandatory BSL and deaf awareness training for frontline NHS staff, underscoring the widespread nature of the issue. The case report serves as a specific illustration of these broader systemic problems.

In 2025, the Royal National Institute for Deaf people reported that as many as 48% of BSL users did not understand their diagnosis, and 53% did not understand the outcome of their consultation. These statistics provide context for the individual case presented in the report, suggesting that the communication failures experienced by the patient are part of a larger pattern within the healthcare system. The authors use these external reports to reinforce their argument that the issues are well known to the deaf population and require urgent attention.

Subject of Research: Communication barriers and interpreter access for deaf patients in NHS hospitals

Article Title: Deaf patients get a raw deal in NHS hospitals, illustrative case history suggests

Article References: Deaf patients get a raw deal in NHS hospitals, illustrative case history suggests. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

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Keywords: British Sign Language, NHS, Deaf patients, Medical communication, Interpreter services, Patient safety, Disability legislation, Hospital care, Informed consent, Healthcare equity, BMJ Case Reports, Communication failures, Staff training, Reasonable adjustments, Frailty assessment, Atrial fibrillation, Chest infection, Blood transfusion, Deep vein thrombosis, Patient-centred care