Readable by Right: Why Leeds Health Appointments Need Accessible Formats as Standard

For most patients a letter from the hospital is an irritation. It arrives, it is read, it joins a pile on the hall table. For a deafblind person in Leeds the same envelope can be the difference between treatment and silence. An appointment card printed in 12-point type is no use to someone who reads braille; a confirmation call to a landline is no use to someone who cannot hear it. The appointment, in any practical sense, never happened.

The appointment nobody could confirm

Picture a routine referral. A GP in Headingley sends a patient to an ophthalmology clinic. The referral is accepted and the hospital writes out with a date eight weeks away. The patient has Usher syndrome, uses a braille display and a guide dog, and told the practice some time ago that correspondence should come by email, with large print for anything posted. That preference sits in a field on the practice system.

When the referral leaves the practice, the field does not travel with it. The letter is printed, posted and never read. A second letter follows, then a warning about discharge. By the time someone rings during working hours, the slot has gone and the patient is back at the start of the queue.

This is not mainly a story about individual carelessness. It is a systems story, and it is precisely the problem the Accessible Information Standard was written to solve.

What the standard asks for, plainly

The Accessible Information Standard has applied to NHS and adult social care providers in England since 2016. It sets out five duties: identify whether a patient has an information or communication need arising from a disability or sensory loss; record that need; flag it prominently in the patient record; share it with other providers when referring or transferring care; and meet it.

Meeting it means supplying information in a format the person can genuinely use, and providing communication support at appointments where it is needed. The menu is wider than many reception desks assume: braille, large print, easy read, audio, British Sign Language video, deafblind manual, hands-on signing, email and text message, plus a lipspeaker, notetaker, BSL interpreter or deafblind interpreter in the room.

None of this is discretionary and none of it is new. What varies, practice by practice and trust by trust, is whether anyone has built the routine that turns a policy into a page a patient can actually hold.

Where the routine breaks down in Leeds

Three failure points recur.

The first is intake. A patient registers at a GP practice and mentions a combined sight and hearing loss. The detail is typed into a free-text notes box rather than the coded fields that trigger alternative formats. Nothing downstream fires. The need has been recorded, but not in a way that does anything.

The second is the boundary between organisations. A flag held by a Leeds GP practice does not appear automatically when the referral lands with secondary care, community services or a private provider working on an NHS contract. Each organisation carries its own duty to ask, record and comply.

The third is the default. Most correspondence is generated from a template, and unless someone has deliberately configured the system to produce an alternative format for a flagged patient, standard print to a postal address will win every time.

Digital routes add a further layer. An NHS App notification, a text reminder or an online booking portal is only accessible if it has been built and tested with screen readers, magnification and braille displays in mind. Swapping an accessible letter for an inaccessible web form is not progress.

Low-cost fixes for practices and clinics

None of the following needs new software, and none is expensive.

Make alternative formats a visible choice at registration, sitting next to the ethnicity question rather than waiting to be raised. Ask about sight and hearing separately, and put the answer into the coded field.

Treat large print as the standing default wherever a sensory need is recorded: 16-point or larger, sans serif, high contrast, uncluttered layout. It is quick, cheap and helpful to far more patients than the flag alone suggests.

Test the email route properly. Email works well for many deafblind people because a screen reader or braille display can read it; it fails when the message is a scanned PDF.

Build a braille and audio workflow with lead times in mind. Transcription takes days rather than hours, so the request should fire when the appointment is booked, not a fortnight before it.

Train reception staff with a short script: which format do you need, who should we contact, and would you like the details read to you while we book.

A checklist for registering an access need

When you register with a practice, or when you next speak to a clinic, ask for the following to be recorded.

• Your preferred format for letters: braille, large print and what size, audio, easy read, email or plain text.
• Your preferred contact method, including whether you use Relay UK, a textphone, or a relative who interprets.
• Your communication needs at appointments: BSL interpreter, deafblind interpreter or guide communicator, lipspeaker, hands-on signing, or a quiet, well-lit room.
• Whether the practice will pass the need on automatically to anyone they refer you to.
• Who at the practice owns the record, and how to correct it if it drifts.

Finish by asking for confirmation in your preferred format. That last step is the real test of whether the system is working.

If the letter still arrives unreadable

Ask the practice manager for a copy of the record showing your communication needs, and ask in writing why the standard was not applied. The NHS complaints process is open to you, and Healthwatch Leeds can advise on how to frame a concern. Leeds Deafblind Hub is glad to help draft that first message.

An appointment letter is a small object. But a health service that cannot tell you when it wants to see you has not yet become accessible, whatever the policy says.