Accessible Information Standard (AIS) Policy and Procedure

Last Reviewed: 23 February 2026 Last Amended: 23 February 2026 Review Interval: Annual

1. Purpose

1.1 To make sure that Service Users (and those important to them) who have a disability, impairment or sensory loss, get information that they can access and understand, and receive any communication support that they need from Pride Home Care Limited.

1.3 Relevant Legislation: The Care Act 2014 Equality Act 2010 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Mental Capacity Act 2005 Access to Health Records Act 1990 Data Protection Act 2018 UK GDPR Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018

2. Scope

Roles Affected: All Staff People Affected: Service Users, Family, Visitors Stakeholders Affected: Family, Advocates, Representatives, Commissioners, External Health Professionals, Local Authority, NHS

3. Objectives

3.1 To ensure that Pride Home Care Limited complies with the NHS Accessible Information Standard, and that staff consider how they will apply the standard in a clear, consistent, transparent and fair way.

3.2 For Pride Home Care Limited to have a clear, consistent, transparent and fair approach to the provision of accessible, inclusive information and communication support to all.

4. Policy

4.1 All staff at Pride Home Care Limited have a responsibility to make information accessible and inclusive.

4.2 Pride Home Care Limited will comply fully with the NHS England Accessible Information Standard and will perform the following six implementation steps:

• Ask: Find out if people have communication and information needs
• Record: Record those needs in a clear and standardised way in electronic or paper-based systems
• Flag: Use alert systems to generate specific formats or to clearly indicate needs to others
• Share: Include records as part of data sharing and treatment and referral processes
• Act: Take steps to ensure people’s information and communications needs are met
• Review: Regularly review needs and ensure records are up to date

4.3 Staff will have a working knowledge of the NHS England Accessible Information Standard, and Pride Home Care Limited will be able to demonstrate compliance through audit and quality assurance processes.

4.4 In line with UK GDPR and data protection legislation, Pride Home Care Limited will enable Service Users to access their records when requested, including the right to review and amend their documented communication preferences.

4.5 Where Service Users are unable to provide consent in relation to the sharing of information, all decisions will be made in line with the Mental Capacity Act 2005 and best interests requirements.

4.6 Pride Home Care Limited will also comply with the Accessibility Regulations that came into force for public sector bodies in 2018, which require reasonable adjustments to be made to websites and mobile apps for those with disabilities.

The regulations require a service’s website to comply with WCAG 2.1 AA by:

• Ensuring that the website is perceivable, operable, understandable and robust
• Having an accessibility statement available on the website

Pride Home Care Limited recognises its obligation to ensure that reasonable adjustments are in place for disabled people.

5. Procedure

5.1 Steps to the Accessible Standard

There are six basic steps which make up the Accessible Information Standard:

• Ask: Find out if people have communication and information needs
• Record: Record those needs in a clear and standardised way in electronic or paper-based systems
• Flag: Use alert systems to generate specific formats or to clearly indicate needs to others
• Share: Include records as part of data sharing and treatment and referral processes
• Act: Take steps to ensure people’s information and communications needs are met
• Review: Regularly review needs and ensure records are up to date

5.2 Step 1 – Ask

At the earliest opportunity, receiving staff must establish any communication needs or wishes in a timely manner.

Before commencing any Care, an assessment will be completed that identifies the communication needs and wishes of the Service User. This will include identifying how the Service User manages communication and what support they will need from staff.

Before commencing Care, Tessa Lucas must determine that Pride Home Care Limited can meet the communication needs of the Service User. Staff must avoid making assumptions about Service Users’ communication needs and must record communication needs specifically and separately from any recording of disability or other protected characteristic status.

5.3 Ongoing Assessment

As part of the Care Plan cycle, assessments will be reviewed in accordance with locally agreed timescales or as a Service User’s condition changes. Staff will revisit and identify any new communication needs and support accordingly.

Tessa Lucas will consider how to promote enabling all individuals accessing Pride Home Care Limited to express their communication needs and wishes. Resources such as posters and leaflets are available via NHS England to help raise awareness that Pride Home Care Limited will accommodate different communication preferences.

5.4 Step 2 – Record

Recording of communication needs and preferences will be highly visible and clear on paper formats, using simple, jargon-free language. Where electronic systems are used, coding must be in accordance with defined terminology, and assurance will be gained that persons receiving shared information understand it.

5.5 Step 3 – Alert / Flag / Highlight

Staff must have systems in place to ensure that records clearly flag that the Service User has a recorded communication need. These flags must be highly visible and prompt staff to take action.

Where facilities are in place for automatically generated correspondence, alerts will pick up the requirement for alternative formats. Staff responsible for overseeing standard print letter releases must have systems in place to not send these where it would be inappropriate or inaccessible. Pride Home Care Limited will investigate and learn from any incidents of this nature.

5.6 Step 4 – Share

Consent will be gained from the Service User who has identified specific communication preferences and needs in relation to sharing this information. Any limitations must be documented, with clarity provided as to what information can be shared, with whom, in what circumstances, and for what purposes.

Where consent cannot be obtained due to reduced capacity, staff should refer to the Mental Capacity Act (MCA) 2005 Policy and Procedure and best interest decisions made in line with the code of practice.

Existing internal and external communication systems such as referral, transfer of Care and handover processes will include reference to communication support required for Service Users.

5.7 Step 5 – Act

Staff must be aware of how to adapt their own communication styles to meet the needs of a Service User, and must be competent with the use of any techniques or aids used by Service Users.

Service Users who use limited or no English, and those who use British Sign Language (BSL) or the deaf-blind manual alphabet, will have access to a professional interpreter. Staff will support the Service User to access this and will work with any advice and support offered by the interpreter.

When supporting Service Users to source an interpreter or communication professional, the following considerations must be taken into account:

• Qualifications
• DBS clearance
• Professional code of conduct
• Experience
• Preference of the Service User (e.g. in relation to gender)
• Specialist skills needed

Any concerns regarding the suitability or practice of an interpreter will be discussed with Tessa Lucas.

5.8 Step 6 – Review

Pride Home Care Limited will regularly review Service Users’ accessible information and communication needs to ensure they remain accurate and appropriate.

This review will occur in line with the Care Plan review cycle, or sooner if there is a significant change in the Service User’s health, communication ability, or care and support setting. Any updates must be clearly documented in the Service User’s Care Plan and promptly acted upon.

5.9 Environment

Staff must always consider whether some rooms are better suited for people with communication needs, for example those with less clutter, improved lighting, or soundproofing. The environment must be considered as part of the Care Plan process, with appropriate locations detailed where specific rooms might better support communication.

Staff will consider lighting, particularly where lip reading is vital for the Service User. Tessa Lucas will accommodate communication aids such as loop systems, in agreement and review with Pride Home Care Limited.

5.10 Conversion of Format

Tessa Lucas must consider in advance how to facilitate the conversion of key documents, policies and procedures in a timely manner, and will identify which communication formats can be used or produced within Pride Home Care Limited, such as email, text message, and large print.

Staff should also refer to the Recite Me tool within QCS Compliance Centre, which supports conversion of policies and resources into different languages, large print and audio, amongst other available functions.

A local suite of support services and points of contact will be made available for accessing specific communication requirements that cannot be met within Pride Home Care Limited. Tessa Lucas will consider how needs can be met through remote, virtual, digital and telecommunications solutions, as well as paper format.

5.11 Reasonable Adjustment Flag (NCRS)

Where Pride Home Care Limited has access to the National Care Records Service (NCRS), reasonable adjustments must be recorded using the NHS Reasonable Adjustment Flag in addition to the Service User’s Care Plan.

This flag enables health and social care professionals involved in the Service User’s direct care and support to view key information about required adjustments, reducing the need for Service Users to repeat their needs and supporting compliance with the Equality Act 2010 and the NHS England Accessible Information Standard (DAPB1605).

When to Record a Reasonable Adjustment Flag

Staff must consider completion of the flag when:

• The Service User has a disability as defined under the Equality Act 2010
• The Service User has a communication need identified under the Accessible Information Standard
• The Service User requests an adjustment
• An assessment identifies a barrier to accessing care, support or health and social care services

Create/Update the NCRS Reasonable Adjustment Flag

Where Pride Home Care Limited has authorised access to NCRS:

1. Log into the National Care Records Service
2. Search for the Service User using NHS number and demographic details
3. Select “Reasonable Adjustment Flag”
4. Record: type of impairment or need (using nationally defined categories), specific reasonable adjustments required, and review date if applicable
5. Save and confirm submission

Review

Adjustments must be reviewed:

• At formal Service User care and support reviews
• If Service Users’ needs change
• At least annually

Guide to Using the Reasonable Adjustment Flag in NCRS: https://digital.nhs.uk/services/reasonable-adjustment-flag/guide-to-using-the-reasonable-adjustment-flag-in-ncrs

5.12 Staff can refer to the Supporting Communication and Sensory Needs Policy and Procedure for practical support and procedures. Time should be factored into accommodating communication needs, as some Service Users may need longer periods of time to process information than others.

5.13 Training and Education

New staff will receive an induction that includes communication. New Care Workers will also be required to complete the Care Certificate, which includes standards around communication.

Ongoing learning will be identified through supervisions and appraisals, and by training needs analysis.

5.14 The Self-Assessment Framework

Pride Home Care Limited will measure its compliance against the set of performance measures by using the self-assessment framework. There are 8 steps to completing the framework:

1. Understand the Accessible Information Standard
2. Assemble a self-assessment team
3. Review current practices
4. Conduct staff and user surveys
5. Undertake gap analysis
6. Develop an action plan
7. Implement the plan and monitor
8. Deliver continuous improvement

NHS England states that organisations should be in a position to annually publish their compliance with the 2025 version by March 2027.

5.15 Audit and Review

Tessa Lucas will ensure that processes are in place to make sure that information recorded is current and accurate. Record keeping audit processes will include a review of the communication preferences of Service Users.

Any findings of discrepancy will be immediately acted upon to ensure the risk of reoccurrence is reduced. Service Users will be supported to provide feedback about their experiences, with information received acted upon as part of the continuous improvement cycle.

6. Definitions

6.1 Accessible Information Information which is able to be read or received and understood by the individual or group for which it is intended.

6.2 Alternative Format Information provided in an alternative to standard printed or handwritten English, e.g. audio, braille or large print.

6.3 Deafblind Deafblindness is a combined hearing and sight loss that causes problems with mobility, communication and access to information.

7. Key Facts – Professionals

• Effective information and communication are vital components of a person-centred approach to care and support
• The Accessible Information Standard was introduced to standardise how organisations consistently meet communication needs of individuals
• There are 6 steps to the Accessible Information Standard: Ask, Record, Flag, Share, Act and Review
• The standard dovetails alongside equality and diversity and data protection legislation
• The standard is mandatory for NHS and social care providers

8. Key Facts – People Affected by the Service

• Pride Home Care Limited recognises that you may have specific communication requirements and will ensure these are accommodated
• Pride Home Care Limited will ensure information is presented in an accessible way and, where appropriate, in a range of languages and formats that are easily used and understood
• Pride Home Care Limited will seek your feedback on information sharing as a means of improving its service

Further Reading

• NHS England – Guide to Using the Reasonable Adjustment Flag in NCRS: https://digital.nhs.uk/services/reasonable-adjustment-flag/guide-to-using-the-reasonable-adjustment-flag-in-ncrs
• Skills for Care – Care Certificate – Communication: https://www.skillsforcare.org.uk/Developing-your-workforce/Care-Certificate/CareCertificate.aspx
• National Register of Communication Professionals Working with Deaf and Deafblind People: https://www.nrcpd.org.uk
• National Register of Public Service Interpreters: https://www.nrpsi.org.uk/
• RNIB – Braille: Tactile Codes: https://www.rnib.org.uk/practical-help/reading/braille-and-moon-tactile-codes
• Sense – Total Communication: https://www.sense.org.uk/get-support/information-and-advice/communication/total-communication/
• RNID – Hearing Loss: https://rnid.org.uk/information-and-support/hearing-loss/
• SignHealth – Who Uses British Sign Language (BSL)?: https://www.signhealth.org.uk/about-deafness/sign-language/
• GOV.UK – Accessible Communication Formats: https://www.gov.uk/government/publications/inclusive-communication/accessible-communication-formats
• The Stroke Association – Aphasia Etiquette: https://www.youtube.com/watch?v=hTh86NoQh7Q
• The Stroke Association – Communication Problems After a Stroke: https://www.stroke.org.uk/resources/communication-problems-after-stroke