FOI 2026/1545

I am writing to request information under the Freedom of Information Act 2000 regarding access to NHS Talking Therapies for Deaf British Sign Language (BSL) users within your Integrated Care Board (ICB) area.

It has now been ten months since responsibility for commissioning specialist BSL Talking Therapies transferred from NHSE to ICB’s under the ‘Who Pays’ guidance. During this period, Deaf BSL users have experienced ongoing delays and barriers to accessing clinically appropriate care, with patients remaining on waiting lists or declining mainstream Talking Therapies due to the known clinical limitations of interpreter-mediated therapy.

The NHS Talking Therapies Manual states:

“The provider will ensure the patient has access to a British Sign Language signer when necessary.”

For Deaf BSL-first patients, patient choice of direct BSL-delivered therapy is a key factor in establishing this necessity.

In this context, please provide the following recorded information:

1. Unmet need and short-term commissioning action
   Please confirm how your ICB intends to address and fund the current unmet need of the [4] Deaf BSL patients currently waiting for NHS Talking Therapies (refusing to use mainstream with interpreter), including any recorded short-term or interim arrangements, for example:

• Individual Funding Requests (IFRs);
• urgent or temporary direct award contracts;
• other interim commissioning mechanisms intended to prevent further delay or harm.

2. Medium and long-term financial planning
   Please provide any recorded information showing how specialist BSL Talking Therapies will be incorporated into your 2026–27 budget envelope and subsequent annual commissioning plans.

3. Reliance on interpreter-mediated Talking Therapies
   If your ICB relies, or intends to rely, on mainstream Talking Therapies delivered with third-party interpreter support for Deaf BSL users, please provide the following recorded information:

• the clinical impact or risk assessments undertaken;
• the equality impact assessments relevant to this decision;
• evidence of consultation with Deaf community representatives or organisations;
• the recorded commissioning rationale for using a pathway where evidence indicates poorer clinical outcomes for Deaf BSL users, including any recorded explanation of how the ICB believes compliance is met with its duties under the Equality Act 2010, the NHS Accessible Information Standard, and current NHS policy commitments to patient choice and personalised care.
• any recorded consideration of the ICB’s responsibilities for safe commissioning and accountability for patient outcomes since the transfer of commissioning responsibility, including how the impact of delayed access, continued unmet need, and extended waiting times for Deaf BSL users has been assessed.

We recognise that ICBs were required to assume responsibility for commissioning specialist BSL Talking Therapies with limited notice ahead of the 2025–26 planning cycle, and that this has taken place within a challenging operational context, including organisational restructuring and wider system pressures.

However, given the passage of time since the transfer of responsibility, and the continued impact on Deaf BSL users who remain waiting for clinically appropriate care, we consider that sufficient time has now passed for compliance adjustments and interim mitigations to be evidenced.

Where ICBs feel that short-term mitigations or longer-term commissioning plans are not yet fully developed, we would welcome the opportunity to engage constructively. We are happy to meet and share best-practice examples adopted by ICBs that have already collaborated with us and established interim arrangements and forward planning for specialist BSL Talking Therapies, should this be helpful.

We hope this request is received in the spirit intended, to support clarity, compliance, and equitable access to NHS Talking Therapies for Deaf BSL users.

1. Unmet need and short-term commissioning action

Our ICB has not decommissioned NHS Talking Therapies for Deaf BSL users. Current access for Deaf BSL patients is provided through translation and interpreter services within mainstream Talking Therapies, consistent with arrangements for other groups who may benefit from a specialist offer but do not have a dedicated service. Examples include patients whose first language is not English or those requiring translation support due to sensory or communication differences.

While no specific interim contracts or temporary direct awards have been put in place, we will consider individual applications for funding SignHealth via our Individual Funding Request (IFR) process.

2. Medium- and long-term financial planning

There are currently no recorded plans to commission a standalone BSL-delivered Talking Therapies service in our 2026–27 budget envelope or subsequent annual commissioning plans. Access for Deaf BSL users continues to be provided via mainstream Talking Therapies with translation support, which is included in the ICB’s existing mental health and therapy provision budgets.

3. Reliance on interpreter-mediated Talking Therapies

Our ICB currently relies on interpreter-mediated mainstream Talking Therapies for Deaf BSL users. No recorded risk assessments, equality impact assessments, or commissioning rationales specifically relating to this approach are held, as no separate decommissioning or new specialist commissioning has taken place.

Provision through interpreter-mediated therapy is a standard NHS approach for groups who may benefit from specialist support but do not have a dedicated commissioned service. As such, no recorded consultations with Deaf community representatives or organisations regarding this approach exist.

We recognise the clinical evidence that BSL-delivered therapy is the preferred approach for Deaf BSL-first patients. NHS England previously commissioned SignHealth for specialist BSL Talking Therapies, but this national commissioning ended on 31 March 2025. Our current approach reflects the common approach agreed across ICBs of providing mainstream Talking Therapies with translation support as the standard pathway.