Everyone’s voice is important.
We know that any service, activity or project is only as good as the voices it includes. If we create something that does not reflect the society we live in, then we fail to support some or potentially many people who need and deserve support.
This guide is designed to help you make sure your activities improve healthcare service for everyone.
“Access tends to be narrowly associated with physical access – for example, can a wheelchair user get into this building and move about freely within it? But access is much more than this. This short guide gives you tips on three main areas of accessibility.
- Physical access –enabling people to negotiate the environment, including the built environment on as equal terms as possible
- Communication access – including people who communicate differently on equal terms
- Cultural access – challenging assumptions that create possible barriers through class, organisational, gender, ethnic, or other cultural factors."*
Patients or carers should also be aware of these issues. By understanding barriers to access, they can challenge organisers and service providers to address all three areas.
Breaking down physical barriers– make it easy to take part
When holding any face-to-face activity such as a meeting, open day or focus group, think about:
- Can people get there by public transport? Do bus and train times tie in with the start and finish time of the event? Would some people need taxis for all or part of their journey?
- Is there parking and how much does it cost? Offer to reserve disabled parking bays if participants have Blue Badges.
- Can you cover travel expenses and how you can make it easy for people to claim? Can people get funds in advance or can you book tickets for them? Is overnight accommodation available to people coming a long way?
- People shouldn’t have to be out of pocket for more than a week. Paying for travel and accommodation upfront is a real barrier to involving people on a low income.
- Is the building accessible? Could you use a ground floor meeting room or is there a suitable lift? Do people with wheelchairs or mobility aids need to use a different entrance?
- Is there more than one accessible toilet in case one is occupied? Does the toilet have enough room for someone in a wheelchair to turn around and lock it from the inside? Is it suitable for someone changing a stoma bag, e.g. are their ledges for them to place their stoma supplies? Are there other toilets near the room? Are there baby changing facilities for families?
- Is there good signage to the toilets and the meeting room? If not, create your own signs. Include images as well as words. Consider putting up the Not Every Disability is Visible sign on the accessible toilet, if there is not one already, so help someone with an invisible disability feel more comfortable using the accessible toilet.
- Is there good lighting in all areas of the room for people with visual impairments to view presentations.
- Are there good acoustics in the room? Check noise levels of activities in adjacent rooms. Choose a venue with a loop system or hire one in as necessary.
- Are there any distractions such as outside noise? Is there air conditioning and can the organisers or venue staff control it?
- Are there breakout rooms to allow small group work without being distracted by other groups?
- If you are providing food and drink, does the venue cater for special diets and allergies? Ask people about their dietary needs in plenty of time to order food.
- Planning regular breaks and telling people they’re free to go to the toilet at any time. Remember people with pain or fatigue may need to leave the event early, even if they planned to stay longer. Offer people who are unwell another way to contribute if they have to leave or can’t come at all.
- Consider people’s religious requirements. Is there a dedicated prayer room or suitable space for someone to pray during the scheduled breaks?
- If possible try to use the same venue if you’re holding a regular panel or reference group.
Breaking down communication barriers - make sure everyone understands
People can face speech, language, hearing or visual barriers when accessing services and taking part in engagement activities.
When arranging activities or producing information online or paper-based, consider:
- If your facilitators have the right skills to put people at ease and support them to contribute effectively, such as:
- listening skills
- non-judgemental approach
- able to ask questions in short, simple sentences
- assertive where necessary and able to steer conversation and handle strong views and emotions.
- Encourage everyone to join in and feel at ease by using:
- ice-breaker activities
- a cabaret style layout
- small group discussions/activities
- a relaxed lunch break, plenty of other breaks and other informal networking times.
- Avoiding jargon and acronyms. Never assume people will know what an MDT (Multi Disciplinary Team) or a CNS (Clinical Nurse Specialist) is. Making people feel stupid creates anxiety and discourages them from taking part.
- Using plain English and make sure written information is in Plain English or Easy Read if you are working with people with a learning disability or English is not their first language. These plain English and Easy Read guides provide top tips for writing in these styles.
- Your font size. Written information should be available in large print (font size 14 or larger) and 12 point as standard. Stick to easy to read fonts like Arial in black and print on white or pale coloured paper so there is clear contrast.
- Using a hearing loop. If a loop system is needed for people with hearing impairments make sure everyone uses the microphone even if people think they are speaking loudly.
- Interpreters. Check in advance if a sign language interpreter or lip-speaker is needed. Deaf people, or where people for whom English is not their first language, may have their own qualified interpreter, but you also need to know where you can contact one. You need to pay interpreters, so budget for this. Always talk to and look at the person speaking, not the interpreter. Allow extra time when using an interpreter and be prepared to explain any terminology or difficult concepts. See NHS England’s Principles for High Quality Interpreting and Translation Services , NHS Scotland’s interpreting Guidelines for Staff and this information about BSL interpreting.
- Preferred formats for people with sight impairment. If you are working with blind or partially sighted people check whether they prefer to use braille, email/web, phone etc.
- When speaking to a blind person, introduce yourself and address them by name. Before you move away, say you are about to leave.
Being inclusive to diversity
For involvement to be meaningful, it must reflect the diversity of the people who use a service. If some groups are not included in the process, services will not reflect their needs and preferences.
People can face barriers to getting involved because of gender, ethnicity, culture, belief, sexuality, age (this can include being young, old or middle aged), health and disability and class. Their needs may not be addressed, they may be being discriminated against and or may not feel comfortable in a particular situation.
Some points to remember:
- Consider how you can reach seldom-heard groups that are frequently left out. Make the most of community organisations that support and represent these groups and make links with them for advice. Examples of seldom-heard groups are (not an exhaustive list):
- the prison population
- people confined to their homes (this can include people with Crohn’s or Colitis during a flare-up or recovering from surgery)
- people with communication support needs
- people with a learning disability
- people with sensory impairments
- asylum seekers and refugee communities
- homeless people
- black and minority ethnic groups
- LGBTQ people (lesbian, gay, bisexual, transgender and questioning their sexuality
- gypsies and travellers
- young carers
- people who are alcohol and drug dependent
- lone parents.
- Choose your method and find out what engagement methods are suited to groups you’re trying to engage. Think about:
- Whether people can read and write well
- The language and dialect people speak
- Whether people have access to the internet
- What kind of venue or location would help people to feel comfortable? Could an activity run alongside another planned event e.g. a focus group as part of a support group meeting or social event?
- Involvement should be diverse and inclusive, so inclusion should extend to both people who are confident and assertive and those who are quite a shy.. A good facilitator will be able to manage both types of personalities to make everyone is given equal time and opportunity to share their views.
- Internal and external barriers people can put people off getting involved. This can create a vicious circle i.e.
- You might make little effort to involve them or deliberately leave them out
- They may not be going through a difficult time and because of this count themselves out. This can be because they are stigmatised or marginalised or because they are not in ‘good place’ mentally or physically.
It takes time and effort to break down internal and external barriers, but it is important to try and do so.
*Peter Beresford, ‘Beyond the Usual Suspects’ Research Report, 2013