At Royal Trinity Hospice, we believe that everyone deserves equitable, compassionate care and a workplace where they feel understood, respected and supported.  

Over the past two years, we have been working to improve access and inclusion for people who are deaf or have hearing loss - including patients, relatives, staff and volunteers - recognising that this group is often underserved within healthcare, particularly within palliative and end of life care. 

This work has grown into a multidisciplinary quality improvement project that is helping us remove barriers, build confidence and embed deaf insight across our organisation. 

Why this work matters to us 

One in four UK adults has a hearing loss, rising to around 80% of people over the age of 70 (over 67% of the patients we cared for last year were over 70 years old). Despite this, deaf people’s communication and information needs are often not fully considered within health services, contributing to health inequalities and poorer experiences of care. 

Within our local area, there is a higher‑than‑average proportion of deaf people with complex health needs. We also know that deaf staff and volunteers can face additional barriers at work when their needs are not fully recognised or understood. 

Nationally, reports have highlighted that deaf patients are being routinely failed by healthcare systems, reinforcing the importance of local, practical action. We were also struck by the fact that there are no agreed British Sign Language (BSL) signs for hospice or palliative care, creating further challenges for communication and understanding. 

How this project began 

This work began when staff from two areas of Trinity identified the same issue from different perspectives. 

In late 2023, during one of our regular Talk & Tour events, a deaf attendee - supported by a BSL interpreter - asked detailed questions about how we support deaf patients. We realised that we couldn’t answer some of those questions as clearly or confidently as we wanted to. That moment prompted us to reflect and to speak with clinical colleagues. 

At the same time, our clinical teams had already identified gaps in how deaf patients were being supported. When we looked at our data, we saw that fewer than 1% of patients aged 70 and over were recorded by Trinity as having hearing loss - despite national data showing this is extremely common. It was clear that hearing loss was being under‑recognised and under‑recorded, with real implications for care, safety and dignity. From these conversations, our Hearing Loss Working Group was formed. 

What we set out to achieve 

Our aims were to: 

Improve staff knowledge, skills and confidence when working with deaf people 

Ensure our teams are properly resourced to provide equitable, accessible care 

Meet our professional, ethical and legal responsibilities to deaf patients, relatives, staff and volunteers 

Improve our adherence to the NHS Accessible Information Standard and related regulatory expectations 

Above all, we wanted to make deaf insight part of everyday practice at Trinity, rather than treating accessibility as an afterthought. 

What we did 

Improving patient care 

We introduced regular deaf insight workshops for staff across all roles - both clinical and non‑clinical. Clinical teams received additional specialist teaching focused on communication strategies, hearing devices, identifying reversible hearing loss and working effectively with BSL interpreters. 

We improved access to interpretation services and invested in assistive technology, helping staff feel more confident and capable when supporting deaf patients in both inpatient and community settings. 

Supporting staff and volunteers 

Inclusion also means supporting our workforce. We worked to improve managers’ awareness of reasonable adjustments and schemes such as Access to Work by adapting our Management Development Programme, and established a new Staff Disability Network to strengthen peer support and organisational learning. 

We also brought colleagues from HR and Organisational Development into the working group to ensure that improvements were embedded into our people processes, not just frontline care. 

Improving our environment and community engagement 

We worked closely with our Facilities team to advise on improvements to the hospice estate, including soundproofing, visual doorbells and flashing fire alarms - changes that improve safety, dignity and independence for both patients and staff. 

Community engagement has also been central to this work. To date, we have partnered with a local deaf charity to deliver two BSL‑interpreted Talk & Tour events, which have been extremely well received and have also proven to be real learning opportunities for the Trinity team (for example, at one Talk & Tour, a discussion about the preferred sign for “hospice” began a wider conversation about how hospices and the work we do are perceived). These events have also helped our staff gain practical experience of working alongside interpreters and we have another BSL interpreted Talk & Tour planned later in the year. 

What difference this has made 

As a result of this work, patients are now routinely asked about their communication needs, and these needs are clearly recorded and shared across teams. Staff report feeling more confident communicating with deaf patients, and our adherence to the NHS Accessible Information Standard has improved. 

Most importantly, deaf patients have told us they feel more involved, listened to and autonomous in their care. 

One patient shared: 

“Trinity has done everything they can to support my communication needs. They communicate with me via email, help me lipread and during my inpatient stay even gave me a flashing doorbell for my room, so I knew when people were coming in. My vision is accessibility everywhere in healthcare and across society, and they have helped make this happen for me.” 

In December 2025, this work was recognised nationally when our Hearing Loss Working Group was awarded the Hospice UK Improving Inclusivity Award. The award celebrates projects that address inequality and promote equality, diversity and inclusion within hospice care. 

We are incredibly proud of this recognition, which reflects the commitment, collaboration and learning across teams, and the invaluable contributions of deaf patients, staff and community partners who have shaped this work. 

What’s next 

There is still much more to do. Our next steps include expanding specialist education for our community services staff, continuing deaf insight training for all staff, and further embedding accessibility into IT systems, estates planning, recruitment and induction processes. 

We are also committed to sharing our learning with other organisations and applying the same approach to other communication and information needs, including sight loss – we hosted our first sight loss insights session for staff in April. 

We want to build a hospice where deaf people - whether patients, relatives, staff or volunteers - experience care, work and connection on equal terms.