Disabled people use healthcare more than anyone else, and encounter more barriers using it than almost anywhere else. Some are physical: the examination table that does not lower, the scales you cannot stand on, the clinic up a flight of stairs. Some are procedural: booking that only works by phone, letters in print you cannot read. And some are attitudinal — the most dangerous kind.
Diagnostic overshadowing: the barrier that kills
Diagnostic overshadowing is when a new symptom is attributed to your existing disability and never investigated. The wheelchair user whose back pain is “to be expected”. The autistic patient whose distress is read as behaviour rather than illness. The person with a learning disability whose weight loss nobody chases.
This is not a niche complaint. Reviews into the deaths of people with learning disabilities — the LeDeR programme — have repeatedly found people dying years earlier than the general population, with treatable conditions found late or never. Overshadowing is a large part of why.
- Name it in the room: “Please assess this symptom as you would for a patient without my condition.”
- Ask the escalation question: “If a non-disabled patient presented with this, what would you do next?” Then ask for that.
- If you have a learning disability, ask about the annual health check — everyone on the GP learning disability register aged 14 and over is entitled to one, and they exist precisely to catch what overshadowing misses.
The Accessible Information Standard
Since 2016, all NHS and adult social care providers in England have been required to follow the Accessible Information Standard. It is short and specific — they must:
- ask about your information and communication needs,
- record them consistently,
- flag them so they are visible in your notes,
- share them with other providers when appropriate, and
- meet them — large print, braille, easy read, email instead of letters, a BSL interpreter, longer appointments, a quiet waiting space.
An appointment letter you cannot read is not an inconvenience; it is the reason people miss appointments and get discharged from waiting lists. If your surgery or hospital has never asked about your communication needs, tell them the Standard requires it, and ask for your needs to be recorded and flagged today.
A deaf patient who is never offered an interpreter, then marked “did not attend”, then discharged from the list, has not missed an appointment. The appointment missed them.
Physical access: reasonable adjustments apply here too
The Equality Act’s reasonable adjustments duty applies to the NHS exactly as it does to a shop — and it is anticipatory. Adjustments worth asking for by name:
- a height-adjustable examination couch — and where your surgery has none, referral to a site that does, plus a note on their equipment planning
- wheelchair-accessible scales — being told “we’ll skip the weight” for years on end is a real clinical failure with drug-dosing consequences
- longer appointments where communication or moving takes time
- double-handed appointments, home visits, or first-of-the-day slots where waiting rooms are the barrier
- online and email booking as an alternative to phone-only systems — for deaf patients this is not a preference
Getting it fixed
- Ask the practice first, in writing, naming the adjustment. Practices respond to specific requests far better than to general complaints.
- Use PALS — the Patient Advice and Liaison Service — at any hospital trust. They resolve a surprising amount informally.
- Complain formally under the NHS complaints procedure; you normally have 12 months.
- Escalate to the Parliamentary and Health Service Ombudsman if the response fails.
- For commissioning-level problems — no accessible equipment anywhere in the area — complain to the Integrated Care Board, which buys the services.
And if the failure is discrimination rather than bad service — you were refused an interpreter, or turned away because of your assistance dog — that is an Equality Act matter with a six-month limit, separate from the NHS complaints route. See our complaints guide and, for dogs, assistance dog refusals.
Take someone with you when you can, put important requests in writing before appointments, and keep copies. The patient with a paper trail gets the adjustment; the patient with a memory gets an apology.