New RNID research suggests most NHS staff in England have not completed training on the Accessible Information Standard. The result is not just frustration. It is risk. Here is what the Standard means in practice, and what you can do to protect yourself or someone you love.
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TL;DR
RNID research suggests failures in NHS communication with people who have hearing loss remain widespread. Poor application of the Accessible Information Standard can put patient safety at risk. This article explains what accessible healthcare should look like and the practical steps patients can take to ensure they are understood and informed.
On Tuesday 27 January 2026, RNID published findings from Freedom of Information requests that point to a serious gap in accessible healthcare in England. RNID says 92% of NHS staff have not completed training on the Accessible Information Standard (AIS), a standard introduced in 2016 to help ensure people with disabilities and sensory loss can access and understand health information.
If you live with hearing loss, you may read this and feel a mix of anger and resignation. The bigger problem is that communication failures in healthcare don’t stay as “just inconvenient”. They can change decisions, delay treatment, and amplify fear at the moments when people are at their most vulnerable.
This is not about criticising individual clinicians. Many staff want to do the right thing. It is about the reality RNID describes: inconsistent training, fragile processes, and systems that do not reliably capture and act on communication needs.
What the Accessible Information Standard is meant to do
The Accessible Information Standard exists to make sure NHS and adult social care services identify, record, flag, share, and meet a person’s communication needs. In straightforward terms, it is meant to ensure you can do three basic things:
- Access services, for example booking appointments and receiving results without being forced through a phone call you cannot manage.
- Understand information, for example diagnosis details, consent discussions, medication instructions, and next steps.
- Be understood, including access to appropriate communication support such as a qualified British Sign Language interpreter where needed.
RNID frames this within legal duties under the Equality Act and the NHS’s obligations to provide reasonable adjustments. The principle is simple: you should not have to fight for understanding, especially when the stakes are high.
Why this matters clinically, not just emotionally
RNID and SignHealth’s “Still Ignored” report describes situations where the consequences are severe. In RNID’s press release, they cite cases of people not properly understanding a cancer diagnosis, a miscarriage, or end-of-life information.
Even when the outcome is not catastrophic, the pattern is corrosive: people leave appointments uncertain, miss key details, and lose trust. RNID and SignHealth also report behavioural fallout that should alarm any healthcare leader: people avoiding A&E or delaying help for new health concerns because they anticipate communication barriers.
That is the core point. Inaccessible communication is not a “nice to have” issue. It is a safety issue.
Why does it keep happening?
RNID’s release includes a telling detail: when staff say they cannot consistently meet communication needs, they point to familiar operational barriers. Lack of training. Lack of time. Lack of standardised processes. IT systems that do not support the right flags and workflows.
This is why the Accessible Information Standard can look fine on paper yet fail in the moment.
A receptionist may not know how to use a paging system. A clinic may rely on shouted names in a waiting room. A clinician may default to a mask that blocks lipreading without offering an alternative, or may turn to a speech-to-text tool that is not fit for clinical nuance. None of those are moral failings. They are predictable outcomes of weak process design and inadequate training.
What good looks like, in real life
Accessible healthcare is often made up of small, practical behaviours done consistently:
• Asking about communication needs early, and recording them clearly
• Confirming how the patient wants to be contacted, and actually using that route
• Facing the patient, speaking clearly, and keeping sentences concise
• Ensuring one person speaks at a time
• Providing written summaries of key points, including medication changes and next steps
• Arranging interpreters in advance when needed, and not treating this as optional
• Checking understanding, not by asking “Do you understand?”, but by inviting the patient to repeat the plan back in their own words
When these become routine, the appointment becomes safer for everyone. It reduces errors, repeated calls, missed appointments, and complaints. It also saves time in the long run, even if it requires a little more care up front.
A practical checklist you can use now
If you are living with hearing loss, or supporting someone who is, the most useful thing you can do is make your needs explicit, in writing, before you are in the room.
Before an appointment:
- Put your communication needs in writing
Send a short message to the service (GP, hospital clinic, audiology, imaging department) and ask for confirmation that it has been added to your record. - Choose your contact route
If phone calls do not work for you, ask for an alternative such as SMS, email, letter, or online portal messaging for appointments and results. - Ask for a written summary
If the appointment is likely to involve decisions, ask in advance for a written summary of outcomes and next steps. This is particularly important for medication changes and referrals. - If you lipread, say so
Ask the clinician to face you when speaking. If masks are required, ask what the local policy is for safe adjustments (for example stepping back briefly, using a clear mask where available, or ensuring written communication is used alongside speech). - Bring backup
If you can, bring a family member or friend. Not to speak for you, but to reduce cognitive load and help capture details.
During the appointment:
- Start by confirming your needs are visible
A simple “Can you see the note about my hearing loss and communication needs?” is often enough to prompt better behaviour. - Ask for the plan in steps
If information is coming fast, ask: “Can we take this one step at a time, and could you write down the key points?” - Do not bluff understanding
Many people nod to keep things moving. In healthcare, that is a risky habit. It is reasonable to say: “I did not catch that, can you repeat it more slowly?” or “Please write that down.” - Confirm the next step before you leave
Ask: “What happens next, and how will you contact me?” Make sure you agree the method.
After the appointment:
- Review written information promptly
If a letter or portal message arrives and it contains something you did not understand in the consultation, follow up straight away. - Ask for your record to be updated
If you had difficulty, request that your communication needs are clearly recorded and flagged for future visits. - Escalate constructively if needed
If the service repeatedly fails to provide reasonable adjustments, use the NHS complaints route or PALS. Keep it factual: what happened, what you needed, what you are asking to change.
A short script you can copy and paste
Subject: Communication needs for upcoming appointment
Hello, I have hearing loss and I need reasonable adjustments so I can understand my appointment safely. Please record and flag the following:
- Please contact me by [SMS/email/letter/portal], not by phone
- In appointments, please face me when speaking and ensure one person speaks at a time
- Please provide key information in writing, including medication changes and next steps
Please confirm this has been added to my record and shared with the clinic team. Thank you.
If you are supporting an older parent or partner
Many of the most serious communication failures happen when people are tired, anxious, unwell, or in pain. If you are accompanying someone:
• Ask permission to take notes
• Ask the clinician to summarise at the end
• If hearing loss is present but unspoken, name it early and neutrally
• Watch for “courtesy nodding” and slow the conversation down
FAQs
What is the Accessible Information Standard?
The Accessible Information Standard is a legal requirement introduced in England in 2016. It requires NHS and adult social care services to identify, record, flag, share, and meet the communication needs of people with disabilities or sensory loss, including hearing loss. Its purpose is to ensure patients can access services and understand information about their health safely.
Does the NHS have a legal duty to support people with hearing loss?
Yes. Under the Equality Act, NHS services must make reasonable adjustments so people with hearing loss are not disadvantaged. The Accessible Information Standard sets out how those duties should be delivered in practice, including alternative contact methods, communication support, and accessible information formats.
What problems do people with hearing loss face in NHS appointments?
Common issues include being contacted only by phone, staff not being aware of communication needs, shouted names in waiting rooms, clinicians wearing masks without alternative support for lipreaders, and a lack of written summaries. These failures can lead to missed information, delayed care, and increased stress.
How can hearing loss affect patient safety?
If a patient cannot fully understand a diagnosis, treatment plan, or medication instructions, the risk of error increases. Research cited by RNID shows some people avoid seeking urgent care altogether due to anticipated communication barriers, which can directly affect health outcomes.
What reasonable adjustments can someone with hearing loss ask for?
Examples include receiving appointment information by email or text instead of phone calls, clinicians facing the patient when speaking, access to a qualified British Sign Language interpreter where needed, written summaries of appointments, and confirmation of next steps in a clear format.
What should I do if my communication needs are not met by the NHS?
You should ask for your communication needs to be recorded and flagged on your record. If problems continue, you can raise the issue with the service directly, contact PALS, or use the NHS complaints process. Keeping requests factual and specific usually leads to better outcomes.
How is RNID involved in improving accessible healthcare?
RNID campaigns for accessible healthcare and monitors how well the Accessible Information Standard is being applied. Its research and Freedom of Information requests highlight gaps in training and implementation across NHS services.
Can family members help during medical appointments for someone with hearing loss?
Yes. Family members or trusted companions can help reduce cognitive load, take notes, and ensure key points are understood. Their role should support the patient’s understanding, not replace direct communication between clinician and patient.
A final word from Alto Hearing
RNID’s findings are a reminder that accessible communication is not a specialist add-on. It is a baseline requirement for safe care.
We work with people who have spent years adapting quietly, taking the strain, and making do. In healthcare settings, that coping can become a hidden risk. You deserve clarity. You deserve to be properly heard, and to properly understand.
If you want help describing your communication needs, preparing for a difficult appointment, or building a hearing plan that supports you in everyday life as well as in clinical moments, Alto can guide you.