Barriers to care - Listening to d/Deaf Rochdale residents voices - Phase 2 Report
To better understand these challenges, we held a focus group in December 2024, supported by two local Deaf interpreters and in partnership with Trudy Taylor, Head of Patient Experience at Northern Care Alliance NHS Trust. This work formed the basis of our Phase 1 Report.
As part of our continued commitment, a second focus group was held on Thursday 10th April 2025 at BACP on Ramsey Street, Rochdale. Once again, we were joined by two local Deaf interpreters and d/Deaf residents from the borough.
Participants expressed frustration that little progress had been made since the last meeting. The biggest concern raised was the continued difficulty in accessing dental care—particularly the unwillingness of some local dental practices to book d/Deaf interpreters, despite repeated requests.
The group stressed that meaningful change is needed and called for greater accountability from decision-makers.
Throughout this report, we will share direct quotes and personal stories from the focus group to give a deeper insight into the lived experiences of d/Deaf residents in Rochdale.
Findings
The d/Deaf participants in our focus group re-identified and highlighted some key barriers to accessing health care across Rochdale and Greater Manchester based on their lived experiences of the services.
Key Barriers to Healthcare for d/Deaf People – Summary
The main issues identified include:
- Lack of BSL Interpreters in Dental settings: Despite legal obligations under the Accessible Information Standard, Dental practices fail to book or offer BSL interpreters, leading to missed or postponed appointments alongside d/deaf residents not being able to have a dental pathway of care. Additionally Emergency dental access is not adapted for d/Deaf needs.
- Communication Barriers: A lack of visual alerts in waiting areas – oftentimes patients miss their turn. Additionally, the use of ‘Two-week rule’ wrongly applied to emergency/short notice interpreting and staff not making use of Emergency interpreting tools (e.g. Sign Live, 999BSL). The 999 system not suitable for d/Deaf users.
- Digital and Technology Barriers: No screen systems to alert patients visually in waiting areas. Many healthcare settings have either unreliable or no accessible Wi-Fi, which creates a major barrier for d/Deaf patients who rely on services like Sign Live for communication. The NHS app is not always accessible to d/Deaf users. Phone-only GP appointment systems and hospital appointments needing to be rearranged via a switchboard only, excludes d/Deaf patients.
- Interpreter Bookings and Appointment Scheduling: Fixed appointment slots with little to no flexibility can make it difficult for d/Deaf patients to receive consistent and effective care. Interpreters are often booked for limited time periods, and if appointments overrun or are delayed, support may not be available throughout the visit. In addition, interpreters are not always given advance details about the appointment, making it harder for them to prepare and provide the best possible support. In hospital settings, some patients reported long delays before a d/Deaf interpreter arrived, causing distress and communication breakdowns. The group also raised concerns about inconsistent interpreter booking policies across services. In some cases, cost-saving measures appear to restrict access to interpreters, further disadvantaging d/Deaf patients and affecting the quality of their care.
- Staff Attitudes and Training Gaps: Reception staff blame interpreters for no-shows and myths persist about interpreter availability and booking pathways. The conversations suggest a lack of health care professionals’ being provided with d/Deaf awareness training.
- Primary Care Issues: GP practices often lacked awareness of d/Deaf needs, failed to use text services for communication, and relied heavily on verbal announcements, creating further barriers.
- Inappropriate Use of Family Members: Family members wrongly used as d/Deaf interpreters. This raises legal, ethical, and safeguarding concerns especially around discussing private or sensitive health issues.
- Equality and Service Planning Issues: d/Deaf residents are a small, identifiable community within Rochdale and are still overlooked in service planning. No localized interpreter training within healthcare trusts and Interpreter pay and terms vary significantly. d/Deaf carers are denied interpreter support if not the patient.
Conclusions
The insights gathered through this engagement with d/Deaf residents and interpreters across Rochdale starkly highlight the persistent and systemic barriers faced by the d/Deaf community when accessing healthcare services. From emergency care and hospital procedures to routine dental visits, the accounts presented show a pattern of unmet needs, miscommunication, and a lack of reasonable adjustments—despite the legal obligations outlined in the Equality Act 2010.
Recurring issues such as the misuse of the “two-week rule,” insufficient or incorrect interpreter bookings, and lack of training not only compromise patient safety but also deeply impact the dignity and autonomy of d/Deaf individuals. The inconsistency of interpreter availability during critical procedures and the reliance on family members for interpretation expose clear safeguarding and clinical governance failures.
It is evident from these discussions that a coordinated and informed approach is needed. This must include comprehensive staff training on d/Deaf awareness, system-wide reforms to interpreter booking procedures, investment in accessible technology, and a firm commitment from all health and care providers to uphold the legal and ethical standards of inclusive care, particularly in dentistry.
By listening to lived experiences and taking tangible action, health and care providers in Rochdale and beyond can move closer to a truly equitable system—one in which the rights, needs, and voices of d/Deaf individuals are not only acknowledged but fully respected.
Recommendations
Under the Equality Act 2010, people who are d/Deaf or have hearing loss have the right to equal access to services.
To improve accessibility and reduce barriers, the report recommends:
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Book Interpreters for Longer Time
d/Deaf patients need more time at hospital. Book interpreters for at least 4 hours. This helps if the appointment is delayed or takes longer than expected.
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Eliminate the mis-use of the “Two-Week Rule”
Some staff say interpreters must be booked 2 weeks in advance. This is not true. Emergency and short notice interpreters are available and should be used.
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Train Staff in d/Deaf Awareness
All healthcare staff should receive mandatory training on how to support d/Deaf patients. This includes not shouting names, understanding communication needs, and not using family members to interpret.
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Make Apps and Systems Accessible
Allow d/Deaf patients to request interpreters using the NHS App or online. Appointment letters should show if a patient needs support. Make sure systems help, not block, access.
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Do Not Use Family Members as Interpreters
Family members should not be used as interpreters in healthcare settings. It is neither safe nor private and can place emotional strain on both the patient and the family member. Only trained, qualified interpreters should be used—they have the right skills, follow strict professional guidelines, and are fully insured to carry out the work.
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Fix Digital Barriers
Show names on screens when it’s a patient’s turn. Give access to free Wi-Fi for apps like Sign Live. Use texts and emails, not just phone calls. d/Deaf patients need better digital support.
These recommended improvements aim to reduce inequalities in healthcare access for the d/Deaf community of Rochdale.