Nicola Shilton is an Assistant Development Worker in the Gloucestershire Health and Care NHS Foundation Trust’s Partnership and Inclusion Team:


Part of my role is supporting service users – patients and carers – with communication difficulties in accessing services. Some of the work that we do is promoting and supporting inclusive practice, people participation, engagement and co-production.

At our Trust, we know that communication is not only about speech. The non-verbal, physical means, such as body language and facial expression is so important to convey meaning and is something we can take for granted. The use of face masks and distancing measures due to the coronavirus pandemic has inevitably had an impact on communicating with patients who have a sensory impairment. Masks block the faces of healthcare workers and hide those important visual cues such as facial expressions and lip reading; the spacing we need to ensure the safety of our staff and patients at this time also has an impact, as does the lack of touch when communicating with our visually impaired patients.

We can all help improving communication by speaking clearly, being patient and giving the person plenty of time when attending appointments. We can position ourselves out of shadow or direct light, decrease background noise where we are able to do so, use gestures and write information down. There are also speech to text apps available which can help too, but early on in the pandemic, it became clear that the Type IIR masks, while crucial for protecting our colleagues, also had some limitations when use by teams such as speech and language therapists, where the patient needs to be able to see the therapist’s mouth, or where a patient needed to be able to lip read due to a hearing impairment.

Our Trust received a supply of clear masks through the national supply chain and, thanks to the hard work and diligence of our procurement and stock management team, these were distributed across the Trust to the teams that needed them. These masks were not able to be used as a Type IIR replacement, due to their construction, but could be used where a 2m distance could be maintained. Feedback on the masks varied and the consensus was that while these masks did have some limited use, in order to be really useful, they would need to be the equivalent of a Type IIR mask.

Gloucestershire Hospitals NHS Foundation Trust identified a clear mask that was a Type IIR equivalent and was cleared by their infection control team for use. After receiving a sample, we have placed an initial order for masks to be trialled by frontline teams. If the feedback is positive, then we will look at ordering more masks as needed. If approved for use, it is hoped the masks will further help to improve communications with our patients who rely on lip reading and facial expression to communicate and connect as well as people who are deaf or hard of hearing, people with a learning disability, a speech difficulty, autism, dementia or for people who English is a second language.