85% of NHS staff say they know how to ask. 70% of us have never been asked.

Those two numbers come from the same report, published in April 2025, and they describe the same system from opposite ends.

RNID and SignHealth surveyed 404 patient-facing NHS staff and 1,114 people in England who are deaf or have hearing loss. Eighty-five per cent of the staff said they know how to find out whether a patient has communication needs. Seventy per cent of the patients said nobody has ever asked them.

Not once.

Hold those next to each other for a second - because everything else here follows from the gap between them.

There's a standard that requires the asking. It's existed since 2016. I'm profoundly deaf, I've been through the NHS plenty - and I can count the times I've been asked on no hands.

There's a standard, and most people have never heard of it

It's the Accessible Information Standard, and as of June 2025 its reference is DAPB1605. If you've got a policy document citing DCB1605, that's the old number, and the document predates the rewrite.

It's made under section 250 of the Health and Social Care Act 2012 - which makes it a mandated information standard rather than guidance. It supports the Equality Act duty to make reasonable adjustments.

It binds more than people assume. NHS trusts and foundation trusts, integrated care boards, GP practices, dentists, pharmacies, optometrists - and all publicly funded adult social care, including private and voluntary sector providers delivering local authority funded support. A small care provider with a council contract is inside it.

And here's the thing I like about it - as somebody who audits process rather than buildings. It doesn't say "be accessible" and leave you to work out what that means. It gives you six stages you can be measured against.

Six stages, and almost everybody fails at the first

Identify

Ask people what their information and communication needs are. The duty is on the service to ask - not on the patient to volunteer.

Record

Write it down consistently, and code it. Electronic records are supposed to use SNOMED CT, which is what makes it data rather than a note in a box.

Flag

Make it visible, so it prompts whoever opens the record next.

Share

Make the need travel with the person, through referral, discharge and handover. A need recorded at the GP that never reaches the hospital has failed here.

Meet

Provide the format or the support - promptly and without unreasonable delay. Those last five words are in the standard and they're worth quoting back.

Review

New in 2025. Reassess what's recorded, because needs change, and an answer given in 2017 isn't a record of current need.

Seventy per cent never being asked means stage one is where it collapses. Which means stages two to six have never been tested for most of the people they exist for.

The staff numbers show you the mechanism. Thirty-two per cent of staff surveyed were unaware of the standard at all, and awareness splits hard by role - 85% of doctors, but only 41% of admin staff.

Admin staff do the registration. They're the ones who would be asking.

I've told you. The flag didn't travel.

Here's the part that doesn't show up in a compliance score.

You explain your access needs at reception. Then again to the nurse. Then again to the consultant's secretary, who rings a number you can't use. Then again when the department moves to a new system and your record apparently didn't come with it.

That's work - and you do it on top of being ill.

Stages three and four exist precisely to stop that. When it happens anyway, the finding isn't that the staff were unhelpful - most of them are trying. The finding is that the flag didn't travel, which is a systems failure wearing a person's face.

The version that actually frightens me is the one where it fails silently. You're sent an appointment letter with a phone number on it. You don't ring, because you can't. You're recorded as not having responded - and then as having missed an appointment.

Nothing in that record says a communication failure happened. It says you didn't turn up.

What 54% actually costs

The figure in that report I can't get past is this one.

Fifty-four per cent of the people surveyed had been forced to rely on a partner, a family member, a friend or their own children to relay information or interpret for them at an appointment, because the access wasn't there. Among those who need a communication support professional, it's 80%.

Fifteen per cent had to use their children.

Think about what that means in the room. Somebody hearing your diagnosis before you've decided how you feel about it. Somebody there while you're asked about your body, your mental health, your continence, your sex life. A child doing that for a parent.

And the quieter cost underneath it: you don't ask the question you actually wanted to ask. You edit yourself - because of who's listening.

A booked interpreter isn't a comfort. It's the only version of that appointment where you get to be an adult on your own.

That's a stage five failure - and the standard has required otherwise since 2016.

The telephone is the whole problem in one object

The equipment side of communication access has its own standards, and a hearing loop is the one most often installed and least often tested. Health and social care run on phone calls. Appointment reminders, results, "give us a ring to rebook".

Every one of those is a closed door for me - and the service doesn't record a closed door. It records a missed appointment.

The entire point of recording and flagging a preference is that email or text stops being a favour you renegotiate with whoever answers, and becomes a fact about you the system holds. In practice you state it once, it gets written somewhere, and the letters keep arriving with a phone number on them.

Provided is also not the same as prompt. An interpreter booked for six weeks' time, or a large print letter that lands after the appointment, gets recorded as provision and functions as absence. That's why "without unreasonable delay" is in the text.

The six questions work outside the NHS too

This is why I use the standard on clients it doesn't formally bind.

Any organisation with a booking system can be asked the same six things, and the answers are usually revealing.

Does anything in your process ask somebody what they need? Where does the answer go, and is it structured or a free-text box? Does it flag to the next person who opens the record? Does it travel between departments, systems and contractors? Is it actually met, promptly, without the person chasing? And is it ever reviewed?

Most places fail at the first question, exactly like the NHS does. Where there's an access requirements box on a form that nobody downstream ever reads - that's a stage three and four failure, and I can describe it precisely rather than calling it "poor communication".

What changed in 2025, and the date to know

The standard was renumbered and rewritten. The review stage is new. There's a self-assessment framework, it's aligned to the CQC assessment framework, and the coding specification was tightened.

The date worth holding: NHS England records an assurance end date of 30 June 2027.

There's also a requirement that providers publish their performance in accessible formats on their own websites. For anybody assessing a service that's a gift. It's a public document, so you can look for it before you go anywhere near the building - and if it isn't there, that absence is the first finding.

What this is actually measuring

Stage one is a cultural question dressed up as a process one.

Asking somebody how they need to receive information assumes they might need something different. It assumes disabled people are expected, rather than accommodated when they turn up.

Seventy per cent never being asked, nearly ten years in, isn't a training gap. It's a statement about who the system was built for. The standard exists because somebody already noticed.