What is deaf insight and why is it a critical health issue?
Dr Natasha Wilcock is a deaf doctor, and is the founder and director of IDA.
1 in 4 UK adults are deaf and this rises to 80% of people in their 70s¹. Deafness can affect all elements of an individual’s identity - their communication, relationships, mental health, and employment, to name a few. However, the needs of deaf people are scarcely taught in healthcare services, leading to avoidable health inequalities for deaf individuals.
Legally, professionally and ethically in the health service, deaf insight is critical.
The Equality Act 2010 protects people from discrimination across all areas of society, including deaf people². The NHS Accessible Information standard necessitates that all those providing health and social care must meet the information and communication support needs of patients with sensory losses- namely deaf people³. Professionally, most healthcare professional’s regulatory bodies require their responsible employees to understand, support and advocate for the needs of their deaf patients. The Royal College of Nursing says nurses and midwives should “facilitate equitable access to healthcare for people who are vulnerable or have a disability” amongst at least 10 other direct links in their curriculum⁴ and the General Medical Council says doctors should “apply appropriate equality and diversity legislation, including disability discrimination requirements” and “make arrangements to communicate effectively” with deaf patients⁵.
Ethically, accessible care is a justice need; deaf people need accessible adjustments and support to be autonomous and receive safe and equitable care.
What is deaf insight?
Deaf awareness is a long-used phrase to describe training to improve the knowledge and understanding hearing people have of the needs of deaf people. However, simple awareness does not always confer the rich diversity of the deaf community and often focuses on the struggles of deaf individuals, rooted in the medical model⁶.
However, deaf insight gives an understanding of the diversity of deafness, insight into our experience and the range of impacts of deafness, both the challenges and the positives including Deaf Gain⁷. Deaf Gain describes the wide-ranging positive impacts of deafness on an individual including diverse communication skills and unique sensory perspectives.
What does deaf insight look like within the NHS currently?
Unfortunately, healthcare professionals do not routinely receive deaf insight or specialist communication skills training⁸. This directly impacts not only their ability to communicate and care for deaf individuals but also means cultural insensitivity with discriminatory language and attitudes towards deaf people remain widespread⁹.
This has a wide range of harmful impacts on deaf patients: a lack of trust in healthcare systems¹⁰, misdiagnoses of presentations, poor understanding of treatments which in turn lead to poor outcomes in patient health¹¹. Deaf volunteers and staff also face these issues in their work, which leads to poor recruitment and retention of deaf staff¹².
There are countless examples demonstrating the harmful impacts of a lack of deaf insight. Recent research describes a Deaf woman who was not provided with a BSL interpreter during a pre surgical consent process and woke up after anaesthetic to find she had her leg amputated, and had not realised this was the procedure she was having¹³. A Deaf woman experiencing a mental health crisis was not given access to BSL interpreters and as such the extent of her crisis was poorly understood. Shortly after receiving inaccessible care, she died by suicide¹⁴.
Even when the communication need is known, healthcare staff lack knowledge and confidence to support deaf people to use assistive listening devices like hearing aids, leaving deaf individuals isolated and struggling.
1 in 4 adults in the UK have a communication need, which one of our essential public services is not addressing. So, what is the solution?
Poor deaf insight is not a deliberate act on the part of healthcare staff but a gap in their training. As a doctor, I received hours of teaching on medical conditions I may never see in a 40 plus year career, but not a minute across a 6 year degree on how to meet the needs of deaf individuals. This is mirrored across all healthcare professionals’ training.
Deaf insight training from those with lived experience of deafness is an effective intervention in improving specialist communications skills and social understanding of healthcare professionals towards deaf people. IDA delivers training rooted in lived experience of deafness and the health service, improving cultural competency, communication skills and confidence amongst staff.
IDA also advocates for access to this training to be universal and for existing services to improve. For example, there should be universal access to an individual’s preferred interpreter or communication support professional at both planned and unplanned encounters, individuals should have access to technology to support their communication such as captions and services should have the facilities to allow an individual to feedback in a way that is accessible to them. Crucially, these service changes are actually already mandated by the NHS Accessible Information Standard, which has been in place since 2016, but organisations are not training on the standard, let alone implementing it¹⁵.
Deaf insight is a critical issue affecting at least 1 in 4 patients accessing healthcare. It is crucial that deaf insight training and inclusive services are on offer universally to prevent further avoidable health inequalities and further deaths. I hope through IDA to equip healthcare professionals to better serve their deaf patients and we encourage everyone involved in health services to join us.
References
Akeroyd MA, Browning GG, Davis AC, Haggard MP. Hearing in Adults: A Digital Reprint of the Main Report From the MRC National Study of Hearing. Trends in Hearing. 2019 Jan;23:233121651988761.
GOV.UK. Equality Act 2010 [Internet]. Legislation.gov.uk. Gov.uk; 2010. Available from: https://www.legislation.gov.uk/ukpga/2010/15/contents
NHS England. NHS England» Accessible information standard [Internet]. England.nhs.uk. 2025. Available from: https://www.england.nhs.uk/accessible-information-standard/
Nursing and Midwifery Council. Future nurse: Standards of proficiency for registered nurses. London, UK: NMC; 2018
General Medical Council. Outcomes for Graduates. London, UK: GMC; 2020
Parliamentary and Health Service Ombudsman. Introduction to the Social and Medical Models of Disability [Internet]. 2015. Available from: https://www.ombudsman.org.uk/sites/default/files/FDN-218144_Introduction_to_the_Social_and_Medical_Models_of_Disability.pdf
Understanding Deaf Gain – Deaf Services Unlimited [Internet]. deafservicesunlimited.com. Available from: https://deafservicesunlimited.com/understanding-deaf-gain/
Giving healthcare students training in British sign language and deaf awareness vital for safety and inclusion [Internet]. 2023 [cited 2024 Jan 2]. Available from: https://www.uwe.ac.uk/news/giving-healthcare-students-training-in-british-sign-language-and-deaf-awareness
STILL IGNORED: THE FIGHT FOR ACCESSIBLE HEALTHCARE 2025 POLICY REPORT ENGLAND [Internet]. Available from: https://rnid.org.uk/wp-content/uploads/2020/05/AIS-policy-report-England-UPDATED.pdf
BDA condemns “life-threatening communication failures” in NHS [Internet]. 2023 [cited 1 May 2026]. Available from: https://bda.org.uk/bda-condemns-life-threatening-communication-failures-nhs/
Sign Health. Sick of It: A Report into the Health of Deaf People in the UK. London, UK: Sign Health; 2014
McKee MM, Smith S, Barnett S, Pearson TA. What are the benefits of training deaf and hard-of-hearing doctors? Academic Medicine. 2013;88(2):158–61. doi:10.1097/acm.0b013e31827c0aef
Locked out: Exclusion of deaf and deafblind BSL users from health and social care in the UK (full report – BSL and English versions) - GOV.UK [Internet]. Www.gov.uk. 2025. Available from: https://www.gov.uk/government/publications/bsl-user-experience-of-health-and-social-care-in-uk/locked-out-exclusion-of-deaf-and-deafblind-bsl-users-from-health-and-social-care-in-the-uk-full-report-bsl-and-english-versions
Imogen Nunn: Prevention of future deaths report - Courts and Tribunals Judiciary [Internet]. Courts and Tribunals Judiciary. 2025. Available from: https://www.judiciary.uk/prevention-of-future-death-reports/imogen-nunn-prevention-of-future-deaths-report-2/
Vass E. Major NHS training gap is putting millions of deaf people at risk [Internet]. RNID. 2026. Available from: https://rnid.org.uk/2026/01/major-nhs-training-gap-is-putting-millions-of-deaf-people-at-risk/