"The failure to provide professional British Sign Language interpreters consistently inflicted profound emotional distress on a grieving family, underscoring a critical breach of accessibility standards and patient care."
This damning indictment from the Parliamentary and Health Service Ombudsman highlights a systemic issue within the NHS where vital communication protocols for deaf patients and their families are being neglected. The case of Alan Graham, a deaf man whose end-of-life care discussions were conveyed by his teenage grandson to his deaf daughter, reveals a deeply disturbing reliance on untrained family members, violating national guidance and compounding the trauma of an already difficult time for the family.
In a deeply distressing case that has brought national attention to the communication failures within the National Health Service, University Hospitals Birmingham (UHB) NHS Trust has been severely criticised by the Parliamentary and Health Service Ombudsman. The Ombudsman’s investigation revealed that hospital staff at the Queen Elizabeth Hospital repeatedly used children to interpret critical, sensitive medical information for their deaf family members, a practice that directly contravenes established national guidance. This egregious oversight caused significant distress to the family of Alan Graham, a 75-year-old man who was profoundly deaf and communicated using British Sign Language (BSL), ultimately impacting their ability to grieve his passing in September 2021.
Alan Graham, a former furniture maker and an avid fisherman originally from Dundee, had moved to Birmingham specifically to be closer to his beloved grandchildren. His daughter, Jennifer Petty, 52, who is also deaf, lodged a formal complaint regarding her father’s care and, crucially, the hospital’s unacceptable reliance on her children as interpreters. The findings of the Ombudsman’s inquiry laid bare the extent of the trust’s failings, confirming that the concerns raised by Ms. Petty were valid and had indeed inflicted profound emotional suffering on her and her family.
One of the most harrowing revelations from the investigation was that clinicians tasked Ms. Petty’s then 16-year-old son with the unimaginable responsibility of explaining to his deaf mother that his grandfather might not survive the night. He was also asked to interpret the sensitive discussion around a "Do Not Resuscitate" (DNR) order, meaning that CPR should not be attempted if Mr. Graham’s condition deteriorated. Mr. Graham tragically died the very next day, leaving his family, particularly his grandson, with the indelible trauma of having conveyed such grave news.
The national guidance on accessible information, particularly the NHS Accessible Information Standard (AIS), explicitly mandates that NHS organisations must identify and record the communication needs of patients, and then take steps to meet those needs. This includes providing professional interpreters for individuals who use BSL. The standard aims to ensure that patients with disabilities, including sensory impairments like deafness, receive information in a format they can understand and have appropriate support to communicate with healthcare staff. The Ombudsman’s report clearly states that UHB NHS Trust failed to adhere to these critical requirements, demonstrating a significant lapse in patient care and a disregard for the rights of deaf individuals.
Over an extensive 11-week period during Mr. Graham’s hospitalisation, professional BSL interpreters were provided on only three isolated occasions. This stark statistic underscores a systemic failure, forcing the family into a role they were neither qualified nor emotionally prepared for. Instead, staff routinely leaned on Ms. Petty’s son and her 12-year-old daughter to translate complex medical terminology and sensitive updates about their grandfather’s deteriorating condition. This placed an immense and inappropriate burden on the children, compromising the integrity of medical communication and exposing them to emotionally overwhelming situations.
Jennifer Petty articulated the deep anguish this situation caused, describing it as "totally unacceptable" that her children were put in such an untenable position. "My children just wanted to visit their grandad and be there for him as family members, but they were constantly being asked to translate by the staff," she explained. "Having to deliver the bad news about my dad’s prognosis was extremely upsetting for all of us." The psychological toll on young individuals forced to relay end-of-life information about a beloved grandparent cannot be overstated; it is an experience that can lead to lasting emotional distress, anxiety, and even secondary trauma.
Rebecca Hilsenrath KC, the chief executive of the Parliamentary and Health Service Ombudsman, reinforced the fundamental principle that public services must be universally accessible. She stressed that deaf patients and their families should never face additional barriers when seeking or receiving healthcare. By consistently failing to provide professional BSL interpreters, the UHB NHS Trust unnecessarily exacerbated the distress experienced by the family during the crucial weeks leading up to Mr. Graham’s death. Ms. Hilsenrath called upon NHS leaders to learn vital lessons from this deeply troubling case to prevent similar occurrences in the future.
Mr. Graham’s journey through the healthcare system began in June 2021 following a fall, which led to a diagnosis of heart failure. After being discharged in August, he was readmitted the following month with a recurrence of similar symptoms, ultimately passing away two weeks later. While the Ombudsman’s investigation concluded that the absence of interpreters did not directly impact the medical treatment Mr. Graham received, it unequivocally caused immense worry and stress to his family. Crucially, it severely limited his daughter’s ability to communicate effectively with clinicians about her father’s condition and care plan, undermining her role as a primary advocate and caregiver.
The repercussions of this systemic failure extend beyond the immediate family. When healthcare providers fail to provide adequate communication support, it creates an environment of mistrust and fear within the deaf community. It reinforces the perception that their unique needs are not valued or understood, leading to potential delays in seeking care, misdiagnosis, and poorer health outcomes. The reliance on family members, especially children, is not only unprofessional but also ethically problematic, as it can lead to misinterpretations, omissions, or the softening of difficult truths, all of which compromise informed consent and effective care planning.
In response to the Ombudsman’s findings, the UHB NHS Trust has been mandated to undertake several corrective actions. These include drawing up a comprehensive action plan detailing how they will ensure compliance with accessible information standards in the future, issuing a formal apology to the grieving family, and making compensation payments. The family was awarded £900 to each of Mr. Graham’s grandchildren and £750 to his daughter, Jennifer Petty, acknowledging the significant emotional distress and trauma they endured.
A spokesperson for UHB acknowledged the trust’s failings, stating: "We offer our sincere apologies to [the family] for their experience, at what was a very difficult time for them. We recognise that we did not get things right and understand the impact this had on them." The spokesperson also indicated that since 2021, the trust has introduced measures to support deaf patients, including strengthening awareness and accessibility arrangements to better meet patients’ communication needs. However, the true test of these commitments will lie in their consistent and effective implementation, ensuring that no other family has to endure the kind of communication breakdown that profoundly affected Alan Graham and his loved ones. This case serves as a stark reminder of the ethical and legal imperative for all healthcare providers to ensure equitable access and truly patient-centred care for every individual, irrespective of their communication needs.