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In October 2025, the Courts and Tribunals Judiciary published a prevention of future death report in relation to Imogen Nunn (known as Immy). This report highlighted the lack of British Sign Language (BSL) interpreters available to support deaf patients in the community, and particularly those who are being treated with mental health difficulties.
Immy’s experience was also referenced in Dr Joanna Atkinson’s recent independent report, Locked out: Exclusion of deaf and deafblind BSL users from health and social care in the UK (Disability Unit and Office for Equality and Opportunity, November 2025).
Following these two publications, we have identified key learning for our partners around health and social care access for BSL users in West Sussex. We acknowledge that the issues outlined in the publications are national ones. However, the following information should encourage you to reflect on the processes within your own organisation, and to identify positive change, wherever possible.
In her report, Atkinson recognises that “the lack of access to health and social care services faced by deaf and deafblind British Sign Language (BSL) users in the UK is a decades-long challenge – their systemic exclusion is entrenched and normalised as part of everyday life”. She explains that their exclusion extends from booking appointments and knowing that they’ve been called in the waiting room, to understanding diagnoses and being able to give informed consent to treatment.
Atkinson highlights that, in addition to a lack of BSL support in health and social care settings, there is also a lack of understanding around the varying needs of BSL users. She reminds us that written English communication is not an acceptable alternative to BSL input. In many cases, deaf people have been affected by an inaccessible education, resulting in poor literacy skills, and rendering many forms of written communications an unsuitable substitution. This is particularly relevant when we are considering communication around technical or medical language. Which brings us to some of the challenges faced by services in providing BSL support.
We know that there is a shortage of BSL interpreters across the country, which is impacting the availability of BSL interpreters in health and social care spaces. Atkinson suggests that this shortage in health and social care spaces may be being exacerbated by two factors; lower pay from public sector organisations, and a lack of specialist knowledge amongst interpreters, which is required to understand the medical and legal terminology often needed in these spaces. Atkinson states that just 20.6% of interpreters accept work in healthcare settings, with only 7.65% accepting work in mental health settings.
It is widely understood that direct BSL provision, where a clinician is skilled themselves in BSL, is more effective and accurate than reliance on interpreters. However, providing this type of specialist support has become increasingly more difficult, particularly as services face frequent reorganisations. Atkinson states:
“Specialist sensory teams and specialist social workers – who had a deep knowledge of BSL, Deaf and Deafblind communities and cultures – existed for many years alongside generic social work provision. This changed when government departments separated into adults and children’s services, which meant most specialist teams providing support from birth to death were disbanded, with a shift to teams defined by provision themes (for example, disability teams or mental health teams). This further reduced the focus on specialisms. Today, there are only a handful of specialist sensory social work teams working with deaf and deafblind people.”
So, what is the impact of these challenges on BSL users? Atkinson identified that deaf and deafblind people are “often traumatised by a lack of access to health and social care”. The trauma occurs across a lifetime, and includes: failure of health and social care systems to enable access to their services; to recognise and meet their needs in appointments; to properly assess them; and to provide appropriate treatment, or even to enable appropriate consent to treatment. Atkinson describes these failures as “systemic neglect of their rights to service provision”, which likely contributes to poorer health outcomes for deaf and deafblind people.
In most cases, the best provision for BSL users is what’s known as direct BSL provision. Direct BSL provision is when clinicians or practitioners themselves are trained in BSL, and therefore can communicate with BSL users without the need for interpreters. This reduces misunderstandings, ensures that information is accurate, and creates a respectful and positive environment for BSL users, whilst hopefully leading to fewer instances of missed or misdiagnoses.
Where resources are limited, Atkinson suggests that there are some key areas of health and social care provision which should prioritise training staff in direct BSL provision. These include:
In her independent report, Atkinson has outlined 12 priority actions to reduce inequalities for deaf and deafblind people, and to implement more support in a way that is financially viable. These recommendations are for national bodies, but some of them are relevant, and arguably achievable, for services at a local level.
Health and social care services should consider whether BSL users have access to video relay services to enable them to manage and attend appointments, including appointments which are hosted online. Video relay services enable BSL users to access support from an interpreter through online video calls or programs.
Health and social care services should ensure that all staff undertake training in relation to deaf awareness and BSL awareness. This should include how to communicate effectively, how to book and work with BSL interpreters, and how to use video relay services.
Local authorities should establish and maintain specialist social workers and sensory teams to improve the effectiveness of work with deaf and deafblind adults, particularly for work around safeguarding or statutory assessments. For all health and social care services, direct BSL provision (or in-person interpretation if direct provision is not available) should be used for planned appointments, and in all cases where a deaf or deafblind person is receiving end-of-life or maternity care.
In addition to the 12 priority actions outlined in Atkinson’s independent report, a list of 18 areas for action for service providers and health and social care professionals has been published by the Disability Unit and Office for Equality and Opportunity (November 2025).
These include actions intended for stakeholders such as the Department for Work and Pensions, the Care Quality Commission, commissioners, local authorities, private providers, social workers, not-for-profit organisations, GPs and NHS services, and advocacy organisations.
Please do take a look at these recommendations, to see whether you can contribute towards making a difference to BSL users in your area.
