A significant deadline is approaching for health and social care services in England.
By 30 September 2026, all NHS and other publicly funded health and social care providers must be able to share, read and write reasonable adjustment information through the national Reasonable Adjustment Digital Flag.
But what does that actually mean for deaf people?
And perhaps more importantly, will recording someone’s communication requirements result in those requirements actually being met.
“A patient record saying someone is deaf does not tell healthcare staff how to communicate with them.”
What is the Reasonable Adjustment Digital Flag?
The Reasonable Adjustment Digital Flag is designed to make information about a disabled person’s reasonable adjustments visible and available across publicly funded health and social care services.
Rather than important information remaining within one GP practice, hospital or care provider, the national system enables health and care professionals to record, view and share information about the adjustments an individual requires.
The aim is simple: wherever someone receives care, staff should be able to identify that reasonable adjustments are needed and understand what those adjustments are.
The deadline for full national compliance is 30 September 2026.
By then, providers are expected to have processes to identify, record, flag, share, meet, review and update people’s reasonable adjustment requirements. Their systems must also be capable of connecting with the national infrastructure used to share that information.
Is this a new requirement?
Not entirely.
The legal duty to make reasonable adjustments is certainly not new. Service providers already have duties towards disabled people under the Equality Act 2010.
Neither is the requirement to identify people’s communication needs new.
The NHS Accessible Information Standard has been in place since 2016. It requires NHS and publicly funded adult social care services to identify, record, flag, share and meet disability-related information and communication needs.
The Accessible Information Standard was significantly updated in 2025. It now describes six essential stages:
Identify. Record. Flag. Share. Meet. Review.
What is changing is the infrastructure supporting this.
The first Reasonable Adjustment Digital Flag Information Standard was published in September 2023. An updated standard was published in December 2025 and set the current deadline for full national implementation.
Interestingly, 30 September 2026 is actually an extension. Full conformance had previously been expected by 31 December 2025. NHS England extended the deadline to allow providers and their software suppliers more time to prepare.
So this is not a new right beginning on 30 September.
It is an important step towards making an existing right work more consistently across different services.
For deaf people, one distinction really matters
A patient’s record saying they are deaf does not tell healthcare staff how to communicate with them.
A deaf person may use British Sign Language.
- They may lipread.
- They may require a lipspeaker.
- They may use speech-to-text reporting.
- They may require an electronic or manual notetaker.
- They may use hearing aids or assistive listening technology.
- They may need communication by email or text rather than telephone.
Some people will use several of these approaches in different situations.
This is something NHS England’s own Accessible Information Standard explicitly recognises. Its implementation guidance warns services not to make assumptions based simply on someone’s disability.
It gives deafness as a specific example: recording that somebody is deaf does not establish whether they use BSL, lipread, use hearing aids or can access written English. Services should identify and record the individual’s actual information and communication requirements.
That distinction is crucial.
Diagnosis or disability is not the same thing as communication need.
The national system specifically recognises lipspeakers
One particularly important aspect of the Reasonable Adjustment Digital Flag is the level of detail that can be recorded.
The national NHS coding structure doesn’t simply contain broad categories such as “hearing impairment”.
Among the recognised entries are:
- Uses British Sign Language
- Uses lipspeaker
- Uses electronic note taker
- Uses speech-to-text reporter
- British Sign Language interpreter needed
- Requires lipspeaker
- Requires manual note taker
- Requires speech-to-text reporter.
There are also codes covering specific contact methods and other communication adjustments.
This matters.
It recognises that communication access for deaf people cannot be reduced to a single solution.
A BSL interpreter and a lipspeaker are not interchangeable. Neither is a speech-to-text reporter simply an alternative name for either of them.
The appropriate provision depends upon the individual.
Recording access is not the same as providing access
This may ultimately be one of the biggest tests of the new system.
A Digital Flag can tell a hospital that a patient requires a lipspeaker. It cannot, by itself, put a lipspeaker in the room.
For the system to make a meaningful difference, organisations need appropriate procedures, staff awareness and arrangements for securing the communication professionals and adjustments identified in people’s records.
NHS England’s implementation requirements reflect this. Providers are expected not only to record and share information, but also to meet reasonable-adjustment needs and ensure staff understand reasonable adjustments as part of routine care and treatment.
The updated Accessible Information Standard similarly requires organisations to plan effective service capability to meet identified needs and to quality assure the communication provision they provide.
Technology can make the requirement visible.
People and services still have to act on it.
Frequently Asked Questions
The Reasonable Adjustment Digital Flag is an NHS system for recording and sharing the reasonable adjustments a disabled person needs when accessing health and social care. It allows relevant information about an individual’s requirements to be visible to staff across different services, helping those adjustments to be identified and provided.
The deadline for full compliance with the Reasonable Adjustment Digital Flag Information Standard is 30 September 2026. Publicly funded health and social care organisations in England are expected to be able to read, write and share reasonable adjustment information nationally by this date.
The Flag can record specific communication requirements rather than simply recording that someone is deaf. NHS codes include requirements such as a lipspeaker, BSL interpreter, speech-to-text reporter and notetaker, as well as lipreading, preferred contact methods and other communication adjustments.
Recording an adjustment is only part of the process. Health and social care providers already have duties relating to reasonable adjustments under the Equality Act 2010, while the Accessible Information Standard requires relevant organisations to identify, record, flag, share, meet and review people’s information and communication needs. The Digital Flag is intended to help make those requirements visible and transferable between services.
Lipspeaker UK provides qualified communication professionals across healthcare and other settings, including lipspeakers, lipspeakers with sign and other specialist communication provision.
If your organisation is reviewing its arrangements ahead of implementation of the Reasonable Adjustment Digital Flag, understanding the different communication requirements recorded within the standard is an important part of being ready to act on them.
NHS England: What is the Reasonable Adjustment Digital Flag?
NHS England: Reasonable Adjustment Digital Flag action checklist