You shouldn’t have to produce a beautifully organised explanation of everything you need while you’re frightened, ill, exhausted or overloaded.
If something about hospital is harder for you because of a disability, neurodivergence, sensory need, communication difficulty, mobility issue, memory problem or another long-term condition, there may be changes that make it easier to access your care.
These are often called reasonable adjustments.
You do not need to know the perfect legal phrase before you ask for help.
You can simply tell staff what is difficult and what would make it easier.
What is a reasonable adjustment?
A reasonable adjustment is a change that helps remove a barrier a disabled person would otherwise face when using a service.
That could be a physical change, but often it is something much simpler.
It might mean:
- somewhere quieter to wait
- a longer appointment or more time to process information
- written information as well as spoken information
- information in Easy Read, large print or another accessible format
- a British Sign Language interpreter or other communication support
- being told before somebody touches you or begins a procedure
- being allowed to have somebody you trust help you communicate, where appropriate
- changes to lighting, noise or the way a waiting area is used, where possible
- knowing clearly what is going to happen next
- changes to the usual way something is done when the usual way creates a barrier for you
This is not about getting special treatment.
It is about making healthcare accessible enough for you to actually use it.
Health services have legal duties around disability access and reasonable adjustments. In England, Scotland and Wales these duties sit within the Equality Act 2010. Northern Ireland has separate disability-discrimination law, but healthcare providers there also have duties to make reasonable adjustments for disabled people.
What counts as reasonable will depend on the situation. Hospitals cannot necessarily do every single thing somebody asks for, particularly where there is a clinical or safety reason not to.
But you are allowed to ask.
Start with the problem, not the legal language
Sometimes “I need a reasonable adjustment” feels like quite a formal sentence to produce when you are already having a terrible day.
You can be much more ordinary about it.
For example:
“I find spoken information very hard to remember. Could you write the plan down for me?”
“Busy waiting areas are overwhelming for me. Is there anywhere quieter I could wait?”
“I need you to tell me before you touch me.”
“I need a bit longer to process questions before I answer.”
“Please speak to me directly as well as the person who is with me.”
“I need my supporter to help me understand and remember information.”
“I find sitting still for long periods very difficult. If it is safe for me to move around, can you tell me where I can go?”
“I need to know when the plan changes or I may still be working from the old one.”
You do not have to explain your entire medical history to make a practical request.
Tell them the barrier.
Tell them what usually helps.
If you know you are going into hospital
It is much easier to arrange some adjustments before you arrive than while everybody is already trying to do seventeen things at once.
For a planned appointment, procedure or admission, you can tell the hospital about your needs when you are booked, during pre-assessment, or when you speak to the department beforehand.
Useful things to ask are:
- Can you put this on my notes?
- Is there a reasonable-adjustments or accessibility section on my record?
- Is there anything you need from me before I arrive?
- Is there a learning-disability, autism or neurodiversity liaison team if that is relevant to me?
- Can I send or bring a health/hospital passport?
- Who should I remind when I arrive?
If you have something written down, bring it.
A paper copy is useful.
Having it on your phone as well is useful too, because paper has an extraordinary ability to vanish inside hospitals.
If you arrive in an emergency
Nobody expects you to have completed a twelve-page accessibility strategy before turning up at A&E.
If you can, tell the first member of staff who needs to know what will help you access care safely.
If talking is difficult, show them something written down.
If you have somebody with you and you want them to help explain, they can do that too.
You may need to repeat important information when you move between departments or teams.
That is frustrating, but it does not mean your request was unreasonable or that you explained it badly. Hospital information does not always travel as neatly as patients do.
Who do i tell?
For an outpatient appointment or planned procedure, that might be:
- the booking or pre-assessment team
- reception
- the nurse looking after you
- the clinician you are seeing
On a ward, you can speak to:
- the nurse looking after you
- the nurse in charge
- the ward sister or ward manager
- your medical team
Some hospitals also have specialist learning-disability, autism or neurodiversity liaison teams.
If you have one of those teams available and it is relevant to you, they may be able to help staff understand and arrange adjustments.
Do not assume something is fixed just because nobody offered an alternative
A lot of hospital life happens according to routine.
Routine is not always the same thing as “this absolutely cannot be changed”.
If something is particularly difficult, ask what is genuinely necessary and what is simply the usual way of doing it.
For example:
“Do I have to wait here, or could I wait somewhere quieter?”
“Do I need to stay by my bed, or can I walk around while I wait?”
“Is this timing fixed, or is there any flexibility?”
“Could you explain why I need to do it this way?”
“Is there another safe way we could do this?”
Sometimes the answer will still be no.
But sometimes it will be yes — and you would never have known if you had not asked.
If the answer is no
A reasonable adjustment is not a guarantee that every request can be met exactly as you asked for it.
There may be a medical, safety or practical reason why something cannot happen in that particular way.
If you are told no and you do not understand why, ask.
You can say:
“Can you explain why that isn’t possible?”
“Is that because of my treatment or because of the usual ward routine?”
“Is there another adjustment that would solve the same problem?”
If you are on a ward and you are still getting nowhere, you can ask to speak to the nurse in charge, ward sister or ward manager.
The aim is not to start a fight with the hospital.
It is to make sure everybody is solving the actual access problem rather than simply repeating the usual routine.
Health and hospital passports
A health or hospital passport is a document that tells health and care staff important information about you.
NHS England’s health and care passport guidance is primarily designed for people with a learning disability and autistic people.
A passport can include things such as:
- how you communicate
- what staff should know about you
- things that make healthcare harder
- reasonable adjustments that help
- how somebody can support you to communicate
- important information staff may need quickly
The important bit is that the passport belongs to you.
You decide what you want to include, who helps you complete it and who you want to share it with.
A health or hospital passport does not replace your clinical record, and it is not a care plan.
It is a quick way of helping staff understand you and how to make your care more accessible.
If you already have one, keep it up to date and take it with you.
NHS England — Health and care passport
Autistic? there is also my health passport
The National Autistic Society has a My Health Passport specifically for autistic people who may need hospital treatment.
It is designed to help communicate needs to doctors, nurses and other healthcare professionals.
National Autistic Society — My Health Passport
If a full passport is more than you need
Not everybody needs or wants a full hospital passport.
Sometimes one page with the important stuff is much more useful.
That is why The Sick List has made:
- Things that might help me in hospital — a general sheet for communication, sensory needs, touch, waiting, changes and overwhelm
- ADHD in hospital — things that might help me — an ADHD-specific sheet for movement, waiting, changing plans, information, autonomy and overwhelm
Things that might help me in hospital
ADHD in hospital — things that might help me
These sheets do not replace a health or hospital passport.
They are simply a quick way to get useful information in front of the person looking after you.
In england: the reasonable adjustment digital flag
England also has a national Reasonable Adjustment Digital Flag.
This is a marker on the NHS record that lets authorised health and care staff see that a person needs reasonable adjustments and can include key information about what those adjustments are.
The idea is that you should not have to start from zero every single time you meet a different NHS service.
If you are in England and have reasonable adjustments that need to be recorded, you can ask your GP or another member of your care team about adding or updating them on your record.
The Digital Flag is useful, but it does not make your paper sheet or passport pointless.
Records, systems and real-life hospital care do not always line up perfectly, so if something is important, tell the people actually looking after you as well.
NHS England — Reasonable Adjustment Digital Flag
A few things worth writing down beforehand
If you have the time and energy, think about these before hospital:
What makes communication easier for me?
What makes waiting harder?
Are there noises, lights, smells, touch or environments I find particularly difficult?
Do I need information written down?
Do I need extra processing time?
Do I need someone I trust to help me communicate or remember things?
What happens when I become overwhelmed?
What helps when that happens?
What might hospital staff mistake for me being difficult when I am actually trying to cope?
You do not need an answer to every question.
You also do not need to predict every possible thing that could go wrong.
Just write down the bits you already know matter.
You are allowed to make your care easier to access
Asking for an adjustment is not being awkward.
Using a passport is not making a fuss.
Needing information twice is not wasting somebody’s time.
Having somebody help you communicate does not mean staff should stop speaking to you.
And asking “is there another way we can do this?” does not make you a difficult patient.
The point of reasonable adjustments is not to make hospital luxurious.
It is to remove unnecessary barriers so you can actually receive the care you came for.