Overview

The Accessible Information Standard (DAPB1605) aims to ensure that people who have a disability, impairment or sensory loss:

• can access and understand information about NHS and adult social care services
• receive the communication support they need to use those services

This guidance helps NHS and adult social care organisations understand their obligations under the standard and provides advice and resources to help them comply with it.

Implementing the standard: an overview

Organisations need to:

• assess their processes for collecting, recording, flagging and sharing data against the standard’s requirements
• assess their arrangements for meeting the information and communication support needs of disabled people who have an impairment or sensory loss and those of families and carers involved in care
• assess the capability of their staff to sensitively identify and record information and communication needs, and to provide the support people need
• understand whether they need to raise staff awareness of the importance of accessibility and address issues affecting implementation of the standard
• review education and training and explore whether they can be improved by working with other organisations
• assess what technical changes are needed to implement the standard
• develop a local implementation plan
• conduct reviews and develop and deliver action plans in areas where the organisation needs to improve

Organisations should identify an Accessible Information Standard lead who is responsible for ensuring the standard is met. A board member should assume responsibility for the standard within their portfolio.

The 2016 version of the Accessible Information Standard required organisations to be fully compliant with all aspects of it. Organisations should be in a position to annually publish their compliance with the 2025 version by March 2027.

Implementing the standard

The 6 essential steps

Successful implementation of the Accessible Information Standard means complying with 6 essential steps to meet people’s needs:

1. identifying needs: a consistent approach to identifying people’s information and communication needs
2. recording needs: consistently and routinely recording people’s information and communication needs in their records as well as in clinical management and administration systems. This means:
   • recording people’s needs in electronic systems using SNOMED CT® (or Read v2, CTV3 codes where legacy systems are still in place)
   • using specific definitions to record needs when systems are not compatible with any of the 3 clinical terminologies or where paper-based systems or records are being used
   • recording people’s needs so staff can ensure those needs are met
3. flagging needs: using electronic flags or alerts, or paper-based equivalents, to indicate that an individual has a recorded information and / or communication need, and to prompt staff to act. The flags may include other actions (such as triggering information in an accessible format to be automatically generated) to ensure needs are met (see DAPB4019: Reasonable Adjustment Digital Flag)
4. sharing needs: including recorded data about people’s information and communication support needs as part of existing data-sharing processes, and as a routine part of treatment, ongoing care, referral, discharge and handover processes (for more information see DAPB4019: Reasonable Adjustment Digital Flag)
5. meeting needs: ensuring people receive information that is accessible to them and receive the communication support they need
6. reviewing needs: consistent and regular reviews of people’s information and communication needs in patient or service user records and on clinical management or administration systems

Education and awareness raising

The standard supports behavioural change as well as technical change. Organisations should ensure all staff can access Accessible Information Standard training and NHS England’s Accessible Information Standard e-learning packages.

Annex B provides ‘top tips’ for staff on communicating with patients:

1. tips for clear face-to-face communication
2. tips for clear written communication

Step 1 – identifying needs

Overview of requirements

Staff should identify people’s communication and information needs at registration or on first contact with the service, or as soon as is practical thereafter.

The next time an individual contacts or is seen by the service, their recorded needs should be checked with them and updated. The recorded details need to be specific about the nature of support required.

Although a retrospective search or audit of records to identify people’s needs is not required, it is good practice.

Ways of identifying needs

One of the fundamental principles of the Accessible Information Standard is that people should be asked to define for themselves what their information and communication support needs are. It is these needs and how they best can be met (not the underlying disability itself) that should be recorded. Recording that a person is ‘deaf’, for example, does not explain whether they are able to read written English, if they use British Sign Language (BSL) or are a lipreader and / or hearing aid user.

Do not make assumptions about an individual’s information and communication support needs without consulting them (and, where appropriate, their family or carer).

People must be asked about their needs during their first interaction with the service or at the first possible opportunity. This might be done over the telephone, face-to-face or online and people should be able to choose the method that meets their needs.

Include a standard line in all correspondence asking people to contact the service with details of their information or communication needs.

Example: an email or letter from a GP surgery to its patients to ask for information about their communication or information needs:

Making sure people receive and understand requests for information about their needs

Organisations must consider how to identify and meet the information and communication needs of people who are unable to read letters or other printed information (for example, people who are blind or deafblind). A range of approaches should be used to contact people including telephone calls, emails, face-to-face conversations and contact through an advocate. If staff recognise a need, they should try to ensure that need is met (for example, by booking a British Sign Language interpreter to support a face-to-face conversation).

People identified as likely to have information and communication needs based on existing records (including clinical diagnoses) should be flagged in IT systems so staff are automatically prompted to ask them more about their needs and can record the specific details.

Organisations are not required to undertake a retrospective search or audit of registered people to identify their needs. However, this may help them to understand current levels of unmet need.

Helping people to describe their needs

Many people with information or communication needs may find it difficult to describe what their needs are. 

Some people, particularly those with more significant needs, will be unable to read or complete a written form or to converse with staff unaided. They will need support.

Many people with sensory loss, especially people who have been affected later in life, do not consider themselves ‘disabled’ and may not understand the types of alternative formats or communication support available. In these circumstances, prompts about the types of support available are helpful. Services and staff should familiarise themselves with the more common types of formats and the support individuals with disabilities, impairments or sensory loss may need (see Annex C).

An individual may need support from an interpreter or other communication professional to communicate their needs. The next time the individual accesses the service with a communication professional is an opportunity to talk to them about their needs.

People with a learning disability

Many people with a learning disability (and some people with other communication needs) have a ‘communication passport’, ‘communication book’, ‘hospital passport’ or similar document. This provides a detailed record of their communication needs and preferences. This is a useful source of information and advice for organisations and staff should ask individuals if they have one of these documents. Information can be copied from it into the organisation’s own systems. These documents do not remove the requirement for organisations to maintain their own records.  

It may also be appropriate to ask individuals (and their carers or family members) whether they have had a comprehension assessment (or other assessment of their communication support needs).

If an individual has a learning disability, conversations may take longer and fuller explanations may be necessary, and examples or prompts may be needed to identify their information and communication needs.

‘Have you got a learning disability? Asking the question and recording the answer for NHS healthcare providers’ (Improving Health and Lives: Learning Disabilities Observatory) gives practical advice on identifying the communication needs of people with a learning disability.

‘Improving identification of people with a learning disability’ offers guidance for general practice.

Questions and prompts to identify people’s needs

The standard applies to a wide variety of people, some of whom will not use the language of ‘disability’ to describe themselves. Organisations should encourage staff to ask everyone about their information and communication needs – including people who have not yet been identified as having a disability or do not consider themselves to have a disability – and to use language that individuals are comfortable with to explore these needs.

People should be asked about their needs when staff record their contact details or demographic data and, for consistency, services should agree one or more standard question to identify people’s needs. The initial question(s) should be easy enough for all service users to understand and respond to. People may require prompts or follow-up questions.

Focusing on the standard’s requirements

The standard is focused on people who meet the Equality Act 2010 definition of disability.

It is important for staff to understand the distinction between identifying information and communication support needs under the standard and recording people’s diversity monitoring or protected characteristic information.

Recording that a person is ‘disabled’ as part of diversity monitoring does not indicate their information or communication support needs (if they have any). Also, when recording details about an individual’s disability, organisations should be mindful that this information is classified as special category (or sensitive) personal data and is subject to stricter requirements and should only be recorded where necessary.

Questions to identify information or communication support needs should be asked when recording people’s protected characteristics.

Recording multiple needs

When recording the specific types of information formats and communication support required, multiple categories, should be selected, for example, an individual may need both British Sign Language support and information in large print.

Local authority records

Local authorities should use their record of deafblind people in their catchment areas (mandated under Care and Support for Deafblind Children and Adults (Department of Health, 2014)) and, as part of their duty to maintain up-to-date records, ensure that communication and information needs are included in records. 

When they are added to the record, people should be asked about their communication and information needs. These needs should then be included as part of the record, on other appropriate databases, and in relevant local information sharing protocols.

Local authorities should also consider liaising with their sensory team to identify, contact and update the records of people known to have experience of sensory loss, including registers of people who are severely sight impaired (blind) or sight impaired (partially sighted).

Step 2 – recording needs

Overview of requirements

Information about people’s communication or information needs must be recorded during their initial interaction with the service or, if they are already in the system, during their next interaction.

In electronic systems that use SNOMED CT, Read v2 or CTV3 codes, this must be recorded using the coded data items associated with the subsets defined by this standard.

In electronic systems that use other coding systems or terminologies, or where paper records are used, this information must be recorded in line with the human-readable definitions or categories associated with the data items. 

If a carer or family member who is involved in the individual’s care has information or communication needs, this should be recorded in the notes or care record of the individual they are supporting.

Additional codes or data items may be requested and, if appropriate, released in the future. It is the responsibility of the IT system supplier or lead organisation to ensure the coding used in patient record and administration systems is current and up-to-date.

Systems and documentation must be formatted so that any record of information or communication needs is highly visible to users.

Organisations must ensure that information recorded about people’s needs is accurate. Systems for editing, checking and quality assuring data should be in place.

Where online systems allow people to access their own records, these systems:

• must enable individuals to review the data recorded about their communication and information needs and request changes if necessary
• should enable them to record their own communication and information needs, where appropriate

The GP online services programme has published resources to support greater patient access to online systems.

If IT systems make it impossible to implement any of the above, organisations should develop and deliver an improvement plan to address this.

Guidance on using non-coded systems

Records of needs must enable any member of staff to take action to meet those needs – including someone who has had no previous contact with the individual.

For consistency and clarity, and to support data sharing, integration and interoperability, organisations should record people’s needs using the precise ‘fully specified name’ associated with the relevant data item (also called a ‘human-readable definition’ or ‘category’) or one of the synonyms listed in the Accessible Information Standard terminology document.

For example:

If it is not possible or practical to use these terms or phrases, organisations must record needs in line with all the following:

• the requirements of the standard
• information governance duties
• accepted good record keeping practice
• the need for a third party to understand and act to meet them

Organisations must ensure the amount and type of data recorded about people’s needs, how it is recorded (including the words used) and where it is recorded (including in specific documentation, sections or IT systems) all work together to ensure those needs are met.

If free text boxes or other unstructured sections are used to record people’s needs, organisations must ensure sufficient detail is recorded so all the needs – and the information about how to meet them – is captured.

If any of the above cannot be implemented in existing IT systems, organisations should develop and deliver an improvement plan to address the issues.

The standard includes 4 different types of information and communication support. The Implementing the standard section looks at these categories in detail.

Examples of good and bad practice when recording people’s needs

Bad practice:

• “Mr Smith is deaf”
• “Ms Jones has sight loss in her right eye”

Why is this bad practice?

Neither description helps identify the specific adjustments or support that will help Mr Smith or Ms Jones.

Good practice:  

• “Mr Smith uses a hearing aid and lip reads”
• “Mr Smith needs a British Sign Language interpreter”
• “Ms Jones needs information sent to her in Arial font point size 16”

Why is this good practice?

All these descriptions meet the requirements of the standard because they identify specific needs – and therefore specific support or adjustments that will help people.

Step 3 – flagging needs

Overview of requirements

Communication and information needs must be flagged, highlighted or made highly visible to relevant staff when an individual interacts with the service.

‘Highly visible’ means it will be obvious to any user of the system. In practice, this means one or all the following:

• visible on the cover, title or front page of a document, file or electronic record
• visible on every page of an electronic record (for example, as an alert, flag or banner)
• highlighted on a paper record (for example, using a larger font, a bold font, and/or a distinctive colour)

Flagging needs effectively

The purpose of the standard’s ‘highly visible’ flagging requirements is to ensure that records of needs are seen by staff and prompt action is taken to meet those needs.

If paper records are used, a clear process must be established so staff are aware of how to highlight a record of needs to their colleagues, and of the meaning of relevant notifications or alerts. In hard-copy records, this may involve using larger print, highlights, stickers or other methods. This information should appear on the front cover or the front page of an individual’s records. If there are multiple volumes to an individual’s records, the information or communication support needs should be visible on the front cover or front page of each volume.

If electronic record or administration systems are used and have the capability, a record of information or communication support needs must be flagged (or linked to an alert) to ensure staff are prompted to:

• respond to people’s information and communication support needs

Or:

• automatic processes are triggered that ensure the needs are met (for example, by automatically generating correspondence in an alternative format)

Although not a requirement of the standard, the automatic triggering of action to respond to needs is preferred over manual processes that rely on staff awareness and vigilance. This is reflected in the Accessible Information Standard maturity index in Annex A.

Step 4 – sharing needs

Overview of requirements

Organisations must ensure information about people’s needs is included as part of existing data-sharing processes, and as a routine part of treatment, ongoing care, onward referral, discharge and handover.

Information shared should be formatted in line with relevant SNOMED CT codes (or READ v2, CTV3 codes where legacy systems are still in place) or using the associated human-readable definitions or categories.

Data recorded as part of the standard should be included, with consent, in shared and integrated records. Organisations should use existing systems for sharing patient information such as the National Care Records Service (NCRS), the Summary Care Record (SCR) platform and NHS e-Referral Service.

All data items associated with the 4 subsets of the standard have been included in the ‘inclusion dataset’ (SCR v2.1) for Summary Care Records with additional information. This means that if an individual has ‘additional information’ in their SCR, details of information and communication needs recorded in the GP record using the identified codes will automatically be available to anyone viewing their SCR.

When recording someone’s information and communication needs, GPs or other practice staff should also talk to the individual about the benefits of agreeing to ‘additional information’ being included in their SCR, so their SCR will be synchronised with their GP record as it is updated. The SCR is updated with additional information once the SCR consent setting in the GP system has been changed to ‘express consent for medication, allergies, adverse reactions AND additional information’.

Step 5 – meeting needs

Overview of requirements

Services must provide at least 1 communication or contact method that is accessible to and useable by the person with information and communication support needs. The method(s) must enable the individual to contact the service, and staff must use this method to contact the individual. Examples of accessible communication or contact methods, depending on the needs of the individual, include email, text messages, telephone and text relay.

Information must be provided in at least 1 format that is appropriate to the individual’s recorded needs.  

If IT systems are used to auto-generate correspondence, they must identify a recorded need for an alternative format and either automatically generate correspondence in that format (preferred) or prompt staff to make alternative arrangements. IT systems must prevent correspondence from being sent to a person in a standard format when this is inaccessible to them.

If it is required, professional communication support must be arranged or provided to enable individuals to fully access NHS or adult social care services. This support must facilitate effective and accurate dialogue and allow the individual to participate fully in decisions about their health, care or treatment. 

Appropriate action must be taken to enable people to communicate, including staff modifying their behaviour and supporting the use of communication aids or tools. This includes providing communication support for people accessing outpatient and inpatient services (including long-term care) and people receiving publicly funded NHS or social care while resident in a nursing or care home.

Response times

The standard says organisations must ensure communication support (including professional communication support) and information in alternative formats is provided promptly. Staff should know what options are available (including online and telephone support), how they can be procured, how long it takes and when and how to use them.

Who bears the cost of providing accessible information or communication support?

Where there is a cost to providing a reasonable adjustment, this must be met by the provider of the service as required by the Equality Act 2010.

Stocking alternative formats

The standard says that organisations must provide information in a format that is accessible to the individual; it does not say that all organisations must offer every type of alternative format.

Organisations should put processes in place to ensure they can put information in alternative formats when required (including processes for formats that cannot be produced in-house). These processes should ensure information gets to people promptly.  

Organisations should keep stocks of the most used information and formats.

Organisations should consider value for money and added value when using third parties to produce alternative formats such as:  

• audio (digital audio files and CDs)
• Braille
• easy read
• British Sign Language (digital video file or DVD)

Many local charities and local branches of national charities who work with people with disabilities and sensory loss can produce information in alternative formats for a fee.

It is also worth considering that other local NHS and adult social care providers may have established procurement frameworks for producing alternative formats. Organisations may be able to use these or get advice from those who have put them in place. Local sharing will usually achieve better value for money, especially when the information being sent to service users is duplicated across different local organisations.

Needs versus preferences

The standard says that information must be provided in a format an individual can access and understand.

The standard does not require organisations to always provide information in an individual’s preferred format – although the principles of person-centred care mean they should give due regard to their preferences. An individual’s existing preferences may reflect their needs. For instance, if an individual uses a screen reader, a preference for receiving material via email or text message will help meet their needs. Therefore, it is important to flag needs, rather than relying solely on preferences.

4 types of information and communication support

Overview

The standard defines 4 types of information and communication support needs that must be met by organisations. 4 subsets within the SNOMED CT terminology have been created to categorise these needs:

• “Accessible Information – requires specific contact method”
• “Accessible Information – requires specific information format”
• “Accessible Information – requires communication professional”
• “Accessible information – communication support”

See Annex C for advice about different types of information and communication needs, including the formats and types of support that may be needed by different groups.

This section looks at what each subset covers and what to consider to meet the needs of each.

Subset 1: “Accessible Information – requires specific contact method”

This category relates to the requirement for organisations to provide accessible ways for a person to contact services – and for services to contact individuals using formats and channels that are accessible to them.

Relying solely on a universal contact method for every patient is unlikely to meet this requirement. For example, many service users, including those who are deaf or have some hearing loss, will not be able to use a telephone to book an appointment or receive test results. Alternative communication or contact methods that may be accessible to individuals with information or communication needs include email, text messages, telephone, text relay and the Video Relay Service.

Organisations must ensure an individual’s need to use, or be contacted through, an alternative communication method is flagged or is highly visible to staff so action can be taken.

Plans to replace or upgrade legacy systems that do not enable these needs to be flagged should be developed and implemented.

Subset 2: “Accessible Information – requires specific information format”

This category relates to sending correspondence or providing information to an individual in an alternative (non-standard print or non-print) format.

Organisations must ensure an individual’s recorded need for information in an alternative format is flagged and either triggers the automatic generation of correspondence or communication in an alternative format (preferred) or prompts staff to make alternative arrangements. A standard print letter should never be sent to an individual who is unable to read or understand it unless they have specifically requested it.

Organisations must have effective processes in place to ensure translated or transcribed information is accurate and high quality.

The standard requires information in leaflets (or similar) to be provided in alternative, accessible formats where this supports direct patient or service user care (including self-care). Organisations should consider what their most frequently used leaflets are and make these available in commonly used accessible formats.

Individuals should be signposted to online information that meets their needs and the service provider must ensure this is accessible to them. This must take account of their individual communication needs due to disability, impairment or sensory loss. If online resources are not suitable, alternatives must be provided.

Corporate communications that do not relate directly to people’s care are excluded from the scope of the standard. However, making all content accessible, including online ‘publications’, reduces the number of alternative formats required by people with information and communication needs (see Annexes B and C).

See Annex D for advice on online accessibility standards and how to meet them.

Large print

Many people will ask for printed information in large print – the following features will often help them:

• non-serif fonts (like Arial) are easier to read for most people with visual loss or with a learning disability
• large print means bigger than 16 point size font. People requiring a 16 point size font will usually be able to read a larger font (for example, 20 point)
• printing in a point size bigger than 28 is generally considered to be impractical and unwieldy. Usually, people’s needs will be better met with an alternative format (for example, audio)

Data items within this subset avoid using a general “large print” category. They are specific about font sizes and types of font required. Organisations should confirm the proposed print size meets the need.

Subset 3: “ Accessible Information – requires communication professional

Language service professionals

Qualifications, registration and other assurances

If support from a communication professional is necessary, services must arrange that support and ensure the interpreters and other communication professionals they use are skilled, experienced and qualified.

The relevant body varies depending on the area. The National Registers of Communication Professionals working with Deaf and Deafblind People is an example resource to help you verify people’s qualifications, skills and experience. It provides identification badges as proof of registration.

Organisations must ensure communication professionals have all the following in place:

• the required qualifications in their field
• Disclosure and Barring Service (DBS) clearance
• signed up to a relevant professional code of conduct
• valid recognised professional registration (for example, NRCPD, RBSLI)

Assurance of the above must be obtained, including by reviewing the relevant professional identification or registration.

Communication professionals working with Deaf and deafblind people

Organisations must ensure communication professionals working with Deaf and deafblind people (including British Sign Language interpreters and deafblind interpreters) are registered with the National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD).

Registration confirms they hold suitable qualifications, are subject to a code of conduct and complaints process, have appropriate insurance, hold an enhanced disclosure from the Disclosure and Barring Service, and engage in continuing professional development. The NRCPD includes the following professional categories:

• Interpreter for Deafblind People
• Lipspeaker
• Notetaker
• Sign Language Interpreter
• Sign Language Translator
• Speech to Text Reporter
• Relay-Intralingual Interpreters (RSLI/TSLI) (previously known as Deaf Relay Interpreters)

If a professional is registered with the NRCPD, they can be found using the ‘find and contact a communication professional’ function on the NRCPD website. Users can search all communication professionals of a particular type (for example, sign language interpreters) in a geographical area.

The site also allows registrants to be searched by name, facilitating assurance and verification of an individual’s status. NRCPD registrants can identify themselves in person using an ID card, which they should carry with them when working.  

The NRCPD website shows the ID badges for each of these professional categories.

Where professional communication support for a d/Deaf or deafblind person is arranged through an agency, organisations should confirm with the agency that only NRCPD registrants will be provided. This should be part of any contract or service specification with an agency.

Similarly, where communication support – most usually British Sign Language interpretation – is provided virtually over the internet, organisations should ensure the communication professionals meet the requirements.

More detailed guidance about using professionals who are registered interpreters for deafblind people is in ‘How the standard applies to specific groups’.

Using health and social care staff as communicators or interpreters

If health and social care staff are registered as communication professionals and appropriately qualified or experienced, they may take on the role of communicator or interpreter. The option of using an independent communication professional should always be considered.

If staff can communicate using British Sign Language (BSL) the deafblind manual alphabet or Makaton (or another key word signing system), it may be appropriate for them to communicate with the individual directly, if the individual agrees.

For example, if a practice nurse can communicate in BSL, it would usually be appropriate to arrange for an individual needing BSL support (and consenting to the practice nurse’s support) to be seen by that practice nurse whenever they require access to this service.

The level of skill and knowledge of the health or social care professional in BSL or deafblind manual must be assessed and judged to be sufficient for effective, accurate dialogue. If it is proposed that a member of staff acts as an interpreter or communicator, consideration must be given – with the involvement of the person, family member or carer – as to whether this is appropriate.  

Further advice about specialist Deaf services – where communication between staff and individuals directly in BSL is likely – is provided in ‘How the standard applies to specific groups’.

Using family members, friends or carers as interpreters

Access to appropriate and suitably skilled, qualified and knowledgeable support from a communication professional provides assurance that important information is being relayed and interpreted accurately. This is essential for safe, effective care.

Individuals must be offered professional and registered communication support if they need communication using British Sign Language, deafblind manual or other communication systems. Family or carers should generally not be relied on for this support, as this can increase the risk of inaccuracies and impact the quality of service the individual receives. It may also have implications for the individual’s safety, privacy and safeguarding.

However, it is important to be responsive to people’s needs and preferences. For example, when bespoke, highly personalised communication approaches are being used (especially when individuals have complex needs) or if the service user would benefit from their translator being someone they know (for example, this may apply to some neurodiverse individuals).

The parameters of the involvement of the individual’s family member or carer mustbe agreed with the individual and recorded in their records. This preference must be regularly reviewed, including whenever a new episode of care is proposed or started and whenever a significant decision or choice is being made.

Clinicians and other professionals enabling the use of family members, friends or carers to provide communication support take on the risk of these individuals lacking the skill to communicate or interpret effectively. They also take on the risk of a possible lack of objectivity from the family member, friend of carer, which may affect the accuracy and completeness of the messages conveyed.

Requests for specific professionals

Where possible, organisations should use an individual’s preferred interpreter(s) if they ask for them. This can also help to address intersectional issues, making it easier for individuals to use interpreters who reflect their identities and experiences.

Wherever possible, organisations should also meet requests for:

• a male or female communication professional
• the same professional to provide support throughout a course of treatment

If an individual is undergoing particularly invasive, intensive or sensitive treatment (for example, care relating to pregnancy, maternity or sexual health, radiotherapy and chemotherapy, end of life care and when accessing mental health services) particular effort should be made to accommodate requests for continuity of professional communication support. These preferences should be clearly and objectively recorded in the individual’s records, linked to the record of their specific needs.

Example of an entry in a patient’s record recording their interpreter preferences

Special Requirements 204331000000107: British Sign Language interpreter needed (finding). Prefers interpreter Jane Smith (NRCPD ID 1234567) or, if unavailable, other female interpreter.

Remote access

Communication professionals can offer support over the internet. For example, video relay services and video remote interpreting services enable 3-way conversations between d/Deaf BSL users, BSL interpreters and English speakers. Services like NHS 111 support remote access and are particularly useful in urgent or emergency care settings when it may not be possible to arrange for face-to-face support from a communication professional in time.

Remote services are not a total replacement for face-to-face interpretation or communication support and may not be appropriate in some circumstances (for example, longer appointments).

Where possible, and for routine care, individuals should be given the option of remote or face-to-face interpretation.

When using these interpretation services, organisations must ensure the interpreters meet the qualification and registration requirements.  

Key word signing systems

Key word signing systems like Makaton and Signalong use signs (given as gestures or described in pictures) to enable and support communication. They are most used to support people with a learning disability.

People can ask for information to be provided with the support of a key word signing system as an alternative to standard formats and these systems can also be used as a type of communication support when interacting with services. Key word signers can act as communication professionals in the same way that sign language interpreters and others described above can.  

Key word signing should not be used in place of BSL and vice versa. It should only be used if it is the most appropriate form of communication for the individual concerned.

Subset 4: “Accessible information – communication support”

This category includes health or social care staff adjusting their behaviour to allow for or to provide communication support, as well as providing (or supporting the use of) communication aids or equipment.

For example, an individual who uses a hearing aid and is a lip reader might receive 2 types of support under this category:

• a hearing loop for their hearing aid
• support from their clinician to ensure they have a clear line of sight to the speaker’s lips and face during a consultation

Refer to Annex B for guidance and resources to support awareness raising among and training of staff in this area.

Requests for specific members of staff

Requests from individuals to be seen by a particular member (or members) of staff should be accommodated whenever possible.

Familiarity with the nuances of a staff member, clinician or professional’s dialect, accent or manner of speaking can assist an individual with a disability, impairment or sensory loss to communicate effectively.

Longer appointments

Organisations should accommodate people’s need for longer appointments. For example, an appointment requiring support from a communication professional will take longer because of the 3-way nature of the conversation.

Systems and processes for scheduling and managing appointments should allow this flexibility and commissioners should support it (through tariffs, contracts and performance-management frameworks).

Timing of appointments

Some people may require adjustments to enable them to attend appointments. For example:

• an extended notice period to allow interpreters to be booked
• a less busy time of day to reduce anxiety
• an easily accessible venue
• scheduling at a specific time (for example, to ensure the individual’s family, carer or advocate can attend) 

There are many other reasons why appointments should be adjusted to ensure they are accessible. Some of these will be out of scope of the standard but should still be accommodated. 

Adjustments to ensure people can access appointments should be recorded in people’s records and reviewed at each appointment to check they are up-to-date.

Step 6 – reviewing needs

Once information or communication support needs have been recorded, IT systems must prompt staff to regularly review and update this information – and staff mustensure these reviews and updates are completed. Organisations should clearly describe their processes for reviewing needs as part of implementing the standard.

An individual’s needs may change (for example, their sensory loss might increase) or the most appropriate ways of meeting their needs may alter (for example, they might have started using a screen reader when previously they needed large print). These changing needs must be promptly identified, recorded and met.

This means information about people’s needs should be checked and updated when data in other fields, such as demographic information, is reviewed. Staff should receive prompts from IT systems to do this. During longer appointments, such as health checks, these reviews should be a matter of course.

Use routine service communications and displays within buildings (posters or screens) to ask patients or service users to tell the service about any changes to their information and communication needs.

Example of a quick check with a patient:

Receptionist: I just wanted to check that our records are up to date. In your records it says you need all the letters we send you in large print format. Is that still the case? Is there anything else that would help you?

Establishing a set review period for patients who have not interacted with a service for some time may help identify whether their information or communication needs have become a barrier to attending appointments / using services.

How the standard applies to specific groups

Support for parents, families and carers

• The standard emphasises the importance of addressing the needs of not only patients and service users but also of their families and carers. The following groups are covered by the standard:
• family: family members or other individuals (such as friends or members of an individual’s support network) who have formal caring responsibilities to support someone to access services
• carer: a patient or service user’s carer. SCCI1580: Palliative Care Co-ordination: Core Content defines them as follows: “A carer is a person who is either providing or intending to provide a substantial amount of unpaid care on a regular basis for someone who is disabled, ill or frail. A carer is usually a family member, friend or neighbour and does not include care workers. (Carers (Recognition and Services) Act 1995.)” SCCI1580 also says: “the main carer will be identified by the individual or the person’s GP or key worker if the person lacks capacity to identify one themselves.” The Accessible Information Standard includes the needs of a patient or service user’s main carer, as well as other important or regular informal (unpaid) carers
• parent: the legally recognised parent or guardian of a person aged under 18 or an individual with parental responsibility or delegated authority for a child

If a patient or service user has an identified carer, staff should also check whether their family or the carer has any information or communication needs. If they do, these should be included (wherever possible with the knowledge of the patient and the carer) as part of the patient or service user’s record or notes and flagged appropriately for action.

The same requirements apply to parents. The needs (if any) of one or more parents should be identified and recorded as part of the child’s records. The requirement to flag a parent’s needs (as part of involving the parent in the child’s care and treatment) should be reviewed when the child appears to be Gillick competent, begins to attend the service independently, or reaches the age of 16. 

Identifying children’s needs

Organisations should work within the following guidelines:

• if the child is not Gillick competent, anyone with parental responsibility or delegated authority for the child may identify a child’s communication needs on their behalf
• if the child is old enough to understand the risks and benefits of what is being proposed (in other words, is Gillick competent), the child can identify their own needs. Individuals with parental responsibility or delegated authority may be consulted and may be able to identify a child’s needs on behalf of the child
• if the patient or service user is a young person (aged between 16 and 18) and has capacity to make decisions about their communication needs, the young person should decide what these are

Support for people protected by the Mental Capacity Act 2005

The Mental Capacity Act 2005 is designed to protect and empower individuals who may lack the mental capacity to make their own decisions about their care and treatment. It says that all possible and appropriate means of communication should be used to help individuals decide for themselves. This includes:

• choosing the best time to communicate
• using pictures or objects to clarify points
• breaking down complex information into simple points
• speaking at an appropriate volume and speed
• using language the person can understand

The Mental Capacity Act 2005 Code of Practice says that anyone acting in a professional capacity for (or in relation to) a person who lacks capacity must take account of its guidance. It stresses the need to provide information tailored to the individual’s needs and abilities in the most suitable form.

This fits closely with the requirements of the Accessible Information Standard. If an individual lacks the capacity to make a decision about the sharing of their information and communication support needs – or other aspects relating to these needs – relevant professionals should refer to the Mental Capacity Act 2005 Code of Practice and make decisions in the individual’s best interests.

People’s information and communication support needs may vary over time, increasing during times of crisis or acute illness and decreasing (or disappearing) when the individual is well. Therefore, it is particularly important for services to frequently review and update recorded needs. This may require more regular reviews and, where IT systems allow, prompts for staff at frequent intervals to ensure these reviews happen.

Support for deafblind people

Meeting the information and communication needs of deafblind people will often involve many different types of support and adjustment. Each deafblind person will have different needs. The example below illustrates the different types of support and adjustment that helped one individual manage his diabetes and make decisions about his own healthcare.

Illustrative scenario: providing support for a deafblind person in primary care

Lloyd is 25 and is deafblind. He communicates using deafblind manual but also has a laptop with assistive technology and an attached refreshable Braille display. Lloyd receives 5 hours a week of support from a communicator guide but lives alone.

He has diabetes so often requires blood tests and check-ups with his GP. He has had difficulties with booking GP appointments and getting access to a qualified and NRCPD registered deafblind manual interpreter, which he needs to fully participate in appointments and to access all the information.

When Lloyd registered with his new GP surgery he asked if he could have an introductory appointment with his GP to discuss his communication needs. Between them, they came up with an action plan:

• Lloyd can book appointments by email, rather than the surgery’s normal telephone-based appointment booking system
• the surgery is in contact with a registered interpreter and they arrange for the interpreter to attend whenever he books an appointment
• he can book double appointment slots to allow more time to communicate through his interpreter
• Lloyd is emailed his blood test results to save him having to attend the surgery or wait for his communicator guide to read out printed results
• the GP includes Lloyd’s communication needs in any referral letters to other clinicians

Lloyd can access primary care services in an effective and appropriate way. He can manage his diabetes and feels that he has control of his own health. Staff at his GP surgery have completed sensory loss awareness training, which is now included in their induction package, and several patients have said they have noticed a significant improvement in their care.

Specific considerations relating to deafblind interpreter registration

The standard requires communication professionals to be suitably skilled, experienced and qualified. This section introduces some important caveats and additional considerations to support deafblind people.

Deafblind manual interpretation

Deafblind manual is a form of tactile fingerspelling. Each letter of the alphabet has a sign that is made against the deafblind person’s hand. Words are spelt out letter by letter.

A register of deafblind manual interpreters is held by the National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD). However, there is currently no training or qualification available for people wishing to become deafblind manual interpreters.

Finding a suitable communication support provider may be challenging and it may be necessary to:

• book an interpreter from further away than would normally be considered
• book directly with the interpreter rather than through an agency

When a registered deafblind manual interpreter can’t be booked, communication support for deafblind people may need to be provided by someone who is unregistered but who has the appropriate skills and experience.

If there are problems booking the requested type of interpreter, the deafblind person should be asked if any alternative arrangements could be used as a temporary solution. Measures should be put in place to ensure the necessary interpretative support is available in the future.

Visual frame and hands on BSL variations

Some, but not all, British Sign Language (BSL) interpreters are also able to work with deafblind people who use ‘visual frame signing’ or ‘hands-on signing’:

• ‘visual frame signing’ is an adaptation of BSL where the signs are kept within the deafblind person’s field of vision
• ‘hands-on signing’ is another adaptation of BSL, where the deafblind person feels the handshapes and movements

A BSL interpreter working with a deafblind person who uses visual frame or hands-on signing must have experience of using the method(s). There is a register of BSL interpreters, but no separate registration for interpreters with visual frame or hands-on signing experience. It is therefore vital they are asked about their experience before a booking is made.

Specialist services for Deaf people

Some services, such as specialist Deaf Mental Health Services, are provided specifically for Deaf people, many of whom will use British Sign Language (BSL) as their first, preferred or only means of communication.

Staff working in these services are likely to be proficient in BSL. One of the reasons these services exist is because they allow direct communication between staff and service users that avoids the intrusion of a third person acting as an interpreter.

Implementing the standard will be different in these settings, but its requirements still apply. Organisations providing services in specialist settings are still required to identify, record, flag, share, meet and review people’s information and communication support needs. Specific decisions about the BSL qualifications held by staff working in specialist Deaf services and the circumstances in which professional interpreters should be used will be taken by commissioners at a local level.

It is likely that specialist services will make a far more thorough assessment of communication needs than other services routinely can.

Support for children and young people

Children and young people with information or communication support needs must be provided with the support they need.

The standard does not cover children’s social services. This is because of the limitation in the scope of information standards issued under section 250 of the Health and Social Care Act 2012.

Support for people with multiple or complex needs

Some individuals have multiple or complex needs that require bespoke tools and communication support. These individuals are more likely to use non-standard or non-verbal communication methods and may use a highly personal communication system. For example, an individual might use specific gestures or eye-pointing to make themselves understood. This may require interpretation by someone close to them who understands them well. 

In these instances, services should seek to use the communication devices or tools the individual finds helpful and work with carers, family members, support workers and others to identify and implement the communication approaches that maximise the individual’s involvement and inclusion.

Services may find it challenging to document these personalised communication requirements within standard systems. A ‘communication passport’ or similar document can help supplement records and provide an additional way to understand and share needs. They do not remove the requirement for organisations to maintain accurate, detailed records of people’s needs.

Assessing and assuring compliance

Local assessment and assurance of compliance

The Accessible information standard’s self-assessment framework is designed to help organisations understand their progress in implementing the standard.

All providers should discuss with their commissioner how to demonstrate their compliance. If this is not already in the contract, it should be added at the next suitable point.

Commissioning organisations are required to seek assurance from providers about their compliance with this standard, including evidence of identifying, recording, flagging, sharing, meeting and reviewing needs.

Current operating systems that lack the technical or operational functionality to support the standard should not be used as justification for non-compliance. Instead, organisations should develop an action plan to address the gaps and improve. If a legacy IT system is a barrier, the action plan should monitor progress in meeting the standard and compliance with the standard should be fully addressed when the system is upgraded. Commissioners should monitor this progress.

A formal incident should be recorded each time an individual’s information or communication support needs are not met. This will help the organisation to understand the extent to which people’s needs are not being met and to put actions in place to ensure they are in future.

Organisations must publish an accessible communication policy that includes a complaints process. The policy should help individuals with information and communication needs to feed back on their experience of services and, specifically, to say whether they received information in appropriate formats and the communication support they needed.

Organisations should consider how to capture feedback from individuals with information and communication needs as part of their existing patient experience and engagement. This may require creating relevant materials, such as feedback forms and comment cards, in alternative formats. Mechanisms should also be established to receive feedback in non-standard formats (for example, audio recordings or British Sign Language communications). Face-to-face feedback opportunities supported by relevant communication professionals should also be considered.

Organisations should collaborate with their local Healthwatch organisation(s), patient groups and voluntary and community sector organisations to help people with information and communication needs to provide feedback. These groups may be able to support direct engagement with individuals and communities.

The role of commissioners

Commissioning organisations are subject to the standard themselves and should explicitly include requirements to comply with it as part of procurement or tender documents, service specifications and contracts with providers.

The commissioner is responsible for ensuring any organisation it commissions complies with the standard and meets the needs of relevant individuals. This assurance should be twofold:

• processes are in place to meet people’s needs
• such needs are consistently met

Expectations around assurance and receiving evidence of compliance should be clearly set out and documented.

Commissioners should ensure an accessible complaints process is in place. If an individual raises concerns, the commissioner should ensure the provider develops a suitable action plan with a timeline to resolve them. Regular updates should be provided until the concerns are addressed.

If a commissioning organisation identifies that a provider is not meeting the standard or is failing to provide evidence of compliance, it must take action such as a formal letter, an improvement notice or imposing conditions under a contract. 

While the specific actions may vary between health and adult social care and by provider, the primary focus should be on collaboratively addressing issues to improve services for users.

Commissioners may also wish to include explicit statements about compliance with the standard in their annual reports and business plans, publications about their commissioning intentions, and communications about equality, diversity and inclusion.

They may also wish to consider their role in supporting local or regional initiatives that support cost-effective and efficient implementation of the standard.

Assessing compliance

Compliance with the standard can be assessed in various ways, including evaluating performance against the standard’s criteria. Evidence of compliance may include:

• confirmation the organisation has published an accessible communication policy, an accessible complaints process and an overview of how it is meeting the standard
• evidence the organisation routinely and consistently follows the standard’s 6 steps as part of ‘business as usual’
• appointment of an Accessible Information Standard lead responsible for ensuring the standard is met. Confirmation a board member has assumed responsibility for the standard within their portfolio
• completion of the preparatory action checklist 
• publication of the organisation’s Accessible Information Standard Self-Assessment Framework (or equivalent, if not used). If further work is needed, a timeline to complete it should be identified and agreed with the responsible commissioner

The Accessible Information Standard Self-Assessment Framework and the ‘maturity index’ in Annex A can be used together to help organisations improve their performance and assess progress over time.

Annex A: Resources for Accessible Information Standard leads

A.1: Preparatory action checklist

This checklist will help Accessible Information Standard leads to work through the steps to implement the standard.

• A board member has assumed responsibility for the standard within their portfolio.
• An accessible communication policy that is in line with the Accessible Information Standard has been developed (or modified).
• An approach has been agreed on how to identify people with information or communication needs relating to a disability, impairment or sensory loss.
• A clear process for recording people’s information or communication needs in line with the standard is in place.
• Flags, alerts or prompts have been established to highlight or make people’s information or communication needs highly visible to staff.
• Ways for individuals with communication needs to contact the service, and for the service to contact them, have been identified and a process is in place to meet the need.
• A process for sending out correspondence in alternative formats is in place.
• A process for producing or obtaining information in alternative formats is in place.
• A process for arranging or booking professional communication support is in place.
• A process for booking or arranging longer appointments for people with communication needs is in place.
• Training and briefings have been given to staff to explain the standard. This includes information on the processes to be followed and information about what support staff can provide themselves.
• Consideration has been given to the accessibility of relevant websites and the availability of relevant information online.

A.2: Accessible Information Standard maturity index

This maturity index is designed to help organisations understand their progress in implementing the standard.

Basic

The requirements of the standard are being achieved using paper-based or using electronic work-arounds.

A basic paper-based approach might involve recording people’s information or communication support needs (most probably by hand) and ensuring these are highly visible using a highlighter or sticker system. Prompts for action are relying on staff to maintain vigilance and follow policy – and sharing involves staff remembering to include information in handovers, referral conversations and correspondence. They may need to copy relevant details from records into handover and referral letters. The organisation is relying on highlighter or sticker system on files to alert staff to the need to send out information in alternative formats or to arrange communication support. It is relying on staff awareness and knowledge to ensure this is done appropriately.  

A basic electronic approach would involve recording an individual’s information or communication support needs using free text (using the fully specified names (FSNs) or categories of the data items associated with the 4 subsets of the standard). Staff must manually select and add a flag or alert to a patient’s record when recording needs. Once the flag is applied, a ‘special requirements’, ‘access needs’ or ‘communication needs’ alert appears whenever the record is accessed. Having noticed the alert, staff must then search for relevant information about the type of information or communication needs the patient has and follow relevant policies to meet those needs.

Staff must arrange for information to be produced in alternative formats if an individual requires it.

The service’s website is not screen reader compatible and information is not available in alternative formats online.

Intermediate

The standard is implemented using clear approaches supported by relevant policy but remains somewhat separate from ‘business as usual’ processes. Electronic systems are used, but there is no process automation.

People’s information or communication needs are recorded using SNOMED CT codes (or READ v2, CTV3 codes where legacy systems are still in place). Electronic flags are available (and IT systems prompt for their use) but must be applied by staff when recording people’s needs (they are not automatically applied by electronic systems). These flags are highly visible and prompt staff to act, but they do not send specific alerts or trigger automatic processes.

Staff can manually select and print or produce some alternative formats using standard templates, but they rely on external or bespoke processes for others. Longer appointments and support from communication professionals can be arranged. While there are clear policies, successful implementation relies on staff awareness and their ability to make adjustments in systems.

The service’s website is accessible to some screen reader uses, but there is no information available in alternative formats online.

Advanced

The standard is partly embedded into ‘business as usual’ processes, with some automation in electronic systems.

People’s information or communication needs are recorded using SNOMED CT codes (or READ v2, CTV3 codes where legacy systems are still in place). Electronic flags are automatically applied upon selection of any of the data items associated with 1 of the 4 subsets of the standard. The flags do not trigger any auto-generation of correspondence or other automatic processes to meet people’s needs but are highly visible and prompt staff to act – including sending alerts at relevant points. Staff can manually select and use a range of standard templates to print correspondence and other information in-house in alternative formats. Effective processes are in place to provide longer appointments, and the arrangement of support from communication professionals, and these are supported by clear policies and protocols which can be followed by all staff.

The service’s website is accessible to most or all screen reader users, with some information available online in alternative formats.

Exemplar

The standard is highly integrated into ‘business as usual’ processes and highly automated in electronic systems.

People’s information or communication support needs are recorded using SNOMED CT codes, with flags automatically applied when any of the data items associated with 1 of the 4 subsets of the standard is selected. The electronic flags automatically trigger actions to meet needs without relying on staff. For example, they lead to the automatic generation of correspondence and printed information in alternative formats, the selection of longer appointment times and the sending of appropriate emails to agencies to book communication professionals. Staff input into processes is minimal and prompted by automatic processes. Drop-down lists require staff to record or review people’s needs whenever they contact the service.

Online registration forms include a section about information or communication support needs and this information is directly exported into the patient’s record when provided. The outputs align with SNOMED CT codes and are recorded using those codes. Patients with online access can view, verify and update their records. Full use is made of digital solutions to meet people’s needs, including access to remote BSL interpretation and speech-to-text reporting.

The service’s website is highly accessible, allowing people to access information online using a screen reader or other assistive technology. It includes information in easy read and BSL formats.

Staff in information and communication roles  have received training in deaf awareness, Total Communication approaches, sight loss awareness, basic BSL, and the deafblind manual alphabet. This training supports communication with people in reception areas and helps build rapport, with communication professionals supporting appointments and clinical conversations.

Annex B: Staff resources

B.1 Summary of the Accessible Information Standard

This is an overview of the Accessible Information Standard for staff. Download the overview in Word format.

Overview of the Accessible Information Standard

The Accessible Information Standard (DAPB1605) sets out a consistent approach to identifying, recording, flagging, sharing, meeting and reviewing the information and communication support needs of patients and service users, their families and carers.

It applies to all providers across the NHS and adult social care and supports anyone with information or communication needs relating to a disability, impairment or sensory loss.

It includes people who are blind, d/Deaf, or deafblind as well as people who have a learning disability, people with aphasia, autistic people, or people with a mental health condition which affects their ability to communicate.

The standard’s objective

People using NHS and adult social services who have information or communication needs relating to a disability, impairment or sensory loss must receive:

• accessible information: information they can access and understand. For example, a blind person might need to receive information from their GP practice in Braille
• communication support: any communication support they need to access services and take part in informed decisions about their health and care. For example, a Deaf person might need a British Sign Language interpreter to attend their appointments

What do organisations have to do?

When providing services to people with information and communication needs covered by the standard, organisations must meet requirements across these 6 steps:

1. identify needs: find out if an individual has any communication or information needs relating to a disability or sensory loss and, if so, what they are
2. record needs: record those needs in a clear, unambiguous and standardised way
3. flag needs: ensure recorded needs are highly visible whenever the individual’s record is accessed and action is prompted
4. share needs: include information about people’s information and communication needs as part of existing data sharing processes (and following existing information governance frameworks)
5. meet needs: take steps to ensure individuals receive information they can access and receive appropriate communication support if they need it
6. review needs: regularly review information and communication support needs and repeat the above steps to ensure records are always up to date

More information

Visit www.england.nhs.uk/accessibleinfo or email england.AISQueries@nhs.net.

B.2 Tip sheets for staff

These tip sheets are designed for staff implementing the standard and provide advice on:

• clear face-to-face communication
• clear printed communications

Download these in Word format.

Tips for clear face-to-face communication

• Make sure you have the person’s attention before trying to communicate with them. If they do not hear you, try waving or tapping them lightly on the shoulder.
• Identify yourself clearly. Say who you are and what you do. It may be more relevant to explain your reason for seeing the person rather than your job title.
• Ensure privacy when having sensitive conversations.
• Check you are in the best position to communicate. Usually this will be facing the person but consider whether sitting or standing is more appropriate. Communication at eye level is usually easiest, so if you are speaking to a wheelchair user, sit down to have the conversation if possible. 
• Find a suitable place to talk, with good lighting and away from noise and distractions.
• Speak clearly and a little more slowly than you would do usually, but do not shout.
• Keep your face and lips visible. Do not cover your mouth with your hand, your hair or clothing.
• Use gestures and facial expressions to support what you are saying.
• If necessary, repeat phrases, re-phrase the sentence or use simpler words or phrases.
• Use plain, direct language and avoid using figures of speech like ‘feeling under the weather’ or ‘expecting the patter of tiny feet’. 
• Check if the person has understood what you are saying. Look for visual clues as well as asking if they have understood.
• Encourage people to ask questions or request further information. Ask if they would like anything in writing as a reminder or reference. 
• Try different ways of getting your point across. For example, writing things down, drawing or using symbols or objects to support your point.

Tips for clear written communication

• Use the most accessible format – preferably multiple formats – to meet the needs of as many people as possible. A web page or email may be much more accessible to people with visual impairments – but a printed letter may be suitable for others.
• Use a minimum font size of 12 point, preferably 14 point (which is readable by a significantly greater number of people).
• Use a clear, uncluttered and sans serif font such as Arial.
• Align text to the left margin and don’t justify text.
• Ensure plenty of ‘white space’ on documents, especially between sections. Avoid ‘squashing’ text onto a page and, if possible, include double-spacing between paragraphs.
• Use page numbers.
• If you are printing, think about how people will view your printed document. A letter might be in 14 point, but a poster will usually need to be in a much bigger font size.
• If you are printing, use matt and not gloss paper.
• If printing double-sided, ensure the paper is of sufficient thickness to avoid text showing through from the other side.
• Correctly format documents and use style and accessibility functions or checks. Ensure an easy-to-follow and consistent heading structure.
• For content that is going to be read on screen, always include ‘alt text’ descriptions of diagrams or images. These descriptions should convey the same information to those who cannot see the images as sighted readers have.
• For content that is going to be read on screen, use the most accessible format. Emails and HTML pages are more accessible than Word documents, which are generally more accessible than PDFs. If you can avoid it, don’t include letters as PDFs attached to emails without putting the same content in the body of the email.
• Consider making all ‘standard’ printed letters / documents easier to read using plain English, highlighting important information and supporting text with diagrams, images or photographs.
• Keep track of the electronic originals of documents you print out so you can re-print in larger font or convert to an alternative format.

Refer to the NHS digital service manual for more information on making digital content accessible.

Annex C: Reference guide about specific groups

This section briefly outlines the groups most likely to be impacted by the standard and offers general advice on the support they may need. However, organisations should address the specific needs of each person, which should be determined in conversation with them.

Specific groups

The following groups of patients or service users are impacted most directly by the standard:

• people who are blind or have some visual loss
• people who are d/Deaf or have some hearing loss
• people who are deafblind
• people who have a learning disability

The following groups are also likely to be impacted:

• people with aphasia
• people with a mental health condition that affects their ability to communicate
• people with autism

These categories do not represent all the groups who may be impacted. The standard includes all people, and their families and carers, with information or communication support needs relating to any kind of disability, impairment or sensory loss.

Common types of communication support and alternative formats

Support for people who are blind or have some visual loss

A person who is blind or has some visual loss may need information that is usually written down or provided in standard print in an alternative format such as audio (on CD or as an audio file), Braille, email/screen-readable or large print.

People who are blind, deafblind or have some visual loss may require information by email or screen-readable format, instead of in a printed format. This allows them to use their own assistive technology or software (for example, a screen reader which that converts text to speech). Depending on the software or assistive technology used, they may need information in specific formats like plain text (with or without attachments), HTML, or attachments in Word or PDF format.

A person who is blind or has some visual loss may need visual information provided as anaudible alert. For example, blind people cannot read information on a screen in a waiting room or notice and so will need another way of finding the appropriate room or seat.

Support for people who are d/Deaf or have some hearing loss

A person who is d/Deaf or has some hearing loss may require support from a communication professional, such as a British Sign Language (BSL) interpreter, a BSL interpreter who uses sign-supported English, a lipspeaker, a notetaker, a relay-intralingual interpreter or a speech-to-text reporter (STTR).

A person who is d/Deaf may also need information that is usually provided in standard print in BSL video format.

A person who is d/Deaf or has some hearing loss may need support to communicate because they:

• lipread: the speaker should clearly address the person and face them while speaking, avoid touching or covering their mouth, and ensure conversations are held in well-lit areas
• use a hearing aid: care should be taken to speak clearly. A loop system may support conversation in reception or waiting areas
• use other communication methods

The ability of d/Deaf people to read and understand written English will vary. Do not assume that having a conversation using written notes is an appropriate way of holding a dialogue.

Also, do not assume that because someone is wearing one or more hearing aids, they no longer need any support to communicate. For example, they may be supporting their hearing using lipreading. The person’s communication needs must be established with them in the first instance.

A person who is d/Deaf may need verbal or audio information in the form of visual alerts. For example, many d/Deaf people cannot hear their name being called in a waiting area.

Support for people who are deafblind

Many deafblind people use a combination of different mechanisms to support communication. They may require support from a communication professional, such as:

• a British Sign Language (BSL) interpreter. This interpreter may need particular skills in ‘hands on signing’ and/or ‘visual frame signing’
• a deafblind manual interpreter
• a speech-to-text-reporter (STTR)

A deafblind person may receive support from an identified professional, such as a deafblind communicator-guide or deafblind intervenor. This person would typically accompany the deafblind individual.

A deafblind person may need written information in alternative formats such as Braille or email.

A deafblind person may also need support to communicate using a communication aid (for example, a voice output communication aid (VOCA)) or technique (like Tadoma).

A deafblind person may use non-verbal communication including gestures, pointing or eye-pointing.

Support for people with a learning disability

A person who has a learning disability may need information that is usually provided in English to be provided in an alternative format such as easy read or explained using Makaton.

They may also require support from a communication professional (such as an advocate) during their appointment.

Communication tools or aids may be necessary to help them communicate effectively and they may use non-verbal communication including gestures, pointing or eye-pointing.

They may have a ‘communication passport’ or similar document setting out their information and communication support needs. 

The nature of a person’s learning disability may impact their ability to communicate and therefore the level of support they need. An individual with a mild or moderate learning disability may be living independently and need information in easy read format, with verbal information explained more slowly and simply.

A person with a more severe learning disability is likely to be supported by one or more carers and will need additional support to communicate, including using a communication tool or aid. People with a more severe learning disability are more likely to communicate in non-verbal and non-standard ways.

Annex D – Digital communications

Web accessibility

Increasing web and digital accessibility will reduce (although never remove) the need to produce information in alternative formats and will help some people with information and communication support needs access information directly and without delay.

The standard doesn’t include requirements for the accessibility of health and social care websites and apps, which are governed separately by The Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018.

Organisations should ensure they are meeting the Web Content Accessibility Guidelines (WCAG) 2.2. to level AA.

The NHS digital service manual sets out this requirement. It provides detailed advice on digital accessibility and building accessible content.  

In line with the NHS digital service manual’s service standard, organisations should involve end-users (including people with different types of disability, impairment or sensory loss) when improving the accessibility of their digital services and reflect the specific needs of their service’s users in what they deliver.  

Organisations should consider the needs of all people when designing, redeveloping or evaluating the accessibility of their web pages. For example, as well as ensuring content is accessible for users of assistive technology (such as screen readers), you should make sure websites are easy to navigate, content is written in plain English and information is provided in alternative formats such as easy read or British Sign Language video. All videos should include subtitles or ‘closed captions’.

Following good accessibility practice is likely to make it easier for organisations to meet their obligations under the standard. Web pages that follow accessibility principles (including being properly structured and tagged) are, for example, usually easier to convert into alternative formats, often by automated means.

Emails and text messages

For many people with a disability, impairment or sensory loss, emails and text messages can be a highly effective format.

They can serve as an alternative to telephone communication for d/Deaf people, can often be ‘read-aloud’ by blind people and people with visual loss and make it easier for people to use assistive technologies such as screen readers. Depending on the software or assistive technology being used, a person who is blind or has visual loss may require information to be emailed to them in a specific format (in the body of the email, as a plain text attachment, as HTML or as a Word or pdf document).

Requests to change contact or communication preferences must be actioned accurately and promptly.

Publication reference: PRN00882i