Supporting people with hearing loss – inclusive practice

“My hearing loss is not taken seriously. It’s stressful. I carry all the weight. I continually need to tell them what I need. They ask me to do things I can’t do.” (person with hearing loss who uses Edinburgh Health and Social Care services, 2024)

About this factsheet

This fact sheet supports Edinburgh Health and Social Care Partnership (EHSCP) colleagues to deliver inclusive services to people with hearing loss or who are “hard of hearing”. Separate guidance will be shared on working with deaf BSL users.

It was co-produced with people with hearing loss in 2024 by Communication Inclusion People using information from leading organisations. All direct quotes are from people with hearing loss who use EHSCP services.

Factsheet development was funded by the Scottish Government See Hear Strategy.

What law and policy say services should do

The Equality Act 2010 (the Equality Act) says it is unlawful for public services to discriminate against people. They must make reasonable adjustments for disabled people to avoid disadvantage. For example, by communicating by email or text, and using technology such as hearing loops or personal listeners.

The Patient Rights (Scotland) Act 2011 says people must:

  • be treated with dignity and respect.
  • experience caring and compassionate healthcare.
  • get the information and support they need to access and participate in their care. All communication must be clear, accessible and understood.

The Health and Social Care Standards state everyone should:

  • experience care and support that is right for them
  • be fully involved in all decisions about their care and support
  • enjoy high-quality service premises.

See Hear Strategic Framework for meeting the needs of people with sensory impairment in Scotland 2014 stresses people should be communicated with appropriately. They should be given the support they need when they need it.

Scottish Government inclusive communication guidance – Scottish Government announced in October 2024 that it intends to update national inclusive communication guidance. Public Sector Duty. Regulation will require public bodies to consider and use this guidance.

Challenges accessing services

Accessing one-to-one health and social care services typically involves a person going through these communication steps. People with hearing loss experience challenges at every step.

  • finding out about the service
  • contacting the service
  • having a meeting at home, in the community, at an office or clinic
  • follow up or ongoing interaction with the service.

Here are some challenges people told us or reported in research.

The diversity of hearing loss and individual needs is not always well understood. For example:

  • There are different types and levels of hearing loss. Severity and impact can depend on the situation.
  • Different people have different support needs. People don’t always say they have a hearing loss. Not all use BSL, lip reading, or use or have the aids they need. Some people want a friend to help, others don’t.
  • Hearing aids often don’t work on the phone or in every situation.
  • Facemasks block lip reading so can cause confusion.
  • Staff need to develop skills to communicate with people with hearing loss.
  • Services which limit the channels they use to communicate. For example, phone or online booking only, with no in person or on paper options.
  • Research shows nearly half of people with hearing loss are unable to book their appointments using their preferred method.

“There was only an old phone number on the slip. I couldn’t ring it. I only found out it was the wrong building after I had worked out where it was and travelled there.”

Lack of adjustments

Studies highlight 24-36% of people with hearing loss have experienced negative attitudes and behaviours from admin and medical health staff.

  • “I said I couldn’t phone to book. He said he couldn’t ring for me.”
  • “I was asked to ring in for test results. I told them I can’t, I’m deaf. I asked if I could text or come in. I was told no.”
  • “I can’t use the phone. It’s on my records. Still, they rang and left a voice message.”
  • “I try to sit close to and facing the door to see staff come to the waiting room. They just say my name like anyone else’s. Like I don’t have a disability. It is very hard when it is busy, and I can’t get near the door.”

What you can do – inclusive communication good practice

Be aware of population needs and impacts

  • Edinburgh is home to between 29,006 and 87,600 people with some degree of hearing loss or tinnitus. Around 61,300 are over 70. This will rise to 122,700 by 2034. At any time an estimated 75,700 citizens experience tinnitus. Socioeconomic inequalities, education level and occupation may affect the likelihood of developing hearing loss.
  • People with sensory impairment have poorer health outcomes than other people. They do not have equal access to a range of services.
  • Hearing loss or tinnitus is linked to increased incidence of multiple medical conditions and health inequalities. Untreated hearing loss increases the risk of experiencing cognitive decline, dementia, social isolation, and depression.
  • Hidden and/or untreated sensory loss can be misinterpreted as symptoms of advancing dementia.
  • Sensory impairment is a major contributor to falls, admission to hospital, and onward admission to a care home.

Find out people’s communication needs and preferences

Ask people about their access and communication needs and preferences on referral forms, self-referral forms or on first contact. Record these in personal files and keep your record up to date.

Act on needs and preferences in the way you provide services

  • Access training, guidance and support listed below.
  • Act on the law. Be flexible. Provide adjustments if people ask for them.
  • Read and act on individuals’ recorded communication and access needs before, during and after appointments.
  • Always use communication-inclusive speaking. Break it up, say things in an easy-to-follow order, use simple sentences and everyday words. See detailed guidance below.
  • Always use communication-inclusive writing. Break it up, put in an easy-to-follow order, use simple sentences and everyday words.
  • Do not restrict communication to phone only. Provide the same information on different channels while adhering to your organisation’s digital security rules. Offer two-way communication in person, in print, by text, online by email or webchat, or via Relay UK or a supporter.
  • Provide accessible, up-to-date information on premises including the address, public transport, parking, and hearing loops.
  • Reserve seats for people with communication needs in your waiting area, near the door staff come through to call people in.
  • People may choose to have a supporter such as a family member, friend or paid carer. They can help communication. Accommodate and recognise supporter roles.

When you are interacting with people with hearing loss

Based on information from RNID

  • Before you meet – read the person’s communication and access needs record. They may ask you to speak to a supporter.
  • Meet at or move to a quieter area. Reduce background noise as much as possible.
  • Face the person. Make sure they can see you.
  • Speak clearly. Avoid shouting or speaking too fast or unnecessarily slow. Offer a “personal listener”. See how to borrow one below.
  • Use communication inclusive speaking. Supplement with gestures, pen on paper, text on device screens, or whiteboards.
  • Be patient. Give the person time to speak and respond to you.
  • Use communication inclusive written materials.
  • If someone doesn’t understand you, repeat what you said or phrase it differently.
  • In an emergency or evacuation situation the person should be helped to follow the same procedures as everyone else. Colleagues should be trained in advance to give assistance. Escape information in each room must be communication accessible.

Information and support

Specialist support

Training videos

Guidance

Download as a pdf