Communication in health and social care: types, barriers and what good looks like on a shift

Almost every serious incident I have investigated in twenty years of running services had a communication failure somewhere in it. Not always at the centre, but always present. A dietitian's instruction that reached the care team but not the kitchen. A resident's pain signalled by pacing rather than words, and read as agitation. A night worker who noticed something and did not think it worth writing down. A family who found out about a hospital admission from a neighbour.

Communication is treated in training as a soft skill, which does it a disservice. It is the mechanism by which everything else in care works. This guide covers what communication means in health and social care, why the skills matter, the types of communication used in real services, the barriers that block them, and what good practice looks like on a Tuesday afternoon rather than in a textbook.

The short answer

Communication in health and social care means the exchange of information, needs, feelings and decisions between the person, the people who support them, their family and other professionals. It matters because care is unsafe without it: medicines, risks, preferences and changes in health all travel by communication. The main types are verbal, non-verbal, written, formal and informal, and specialist or alternative methods such as Makaton, easy read, objects of reference and interpreters. Barriers fall into five groups: environmental, sensory or physical, cognitive or language, emotional or cultural, and organisational. Almost all of them can be reduced by something practical, and the service's job is to identify each person's communication needs, record them, and make sure every worker including bank and agency staff knows them.

What communication means in a care setting

Communication is not just talking. In a care home on an average day it includes a worker asking Priya whether she would like a shower, Priya turning her head away, a handover between two shifts, a note in a daily log, a phone call to a GP, a body map, a Makaton sign for finished, a text to a relative, a whiteboard in the office, a raised eyebrow across a dining room, and the tone of voice used when someone asks for the fourth time where their husband is.

Every one of those carries information that affects care. Most of them are never trained, audited or recorded, which is why they fail.

Why communication skills are important in health and social care

There are four honest reasons, and it is worth giving staff all four rather than just the first.

1. Safety. Information that does not travel causes harm: the missed allergy, the diet change that did not reach the kitchen, the deterioration nobody escalated.
2. Dignity and rights. A person who cannot make themselves understood loses control of their own life. Communication is how choice happens.
3. Effectiveness. Care that is not explained is not followed. A person who does not understand why they are being asked to do something will reasonably refuse.
4. Relationships. Staff who communicate well have fewer conflicts, better retention and calmer shifts. Distress is often a communication problem before it is a behaviour problem.

The legal backdrop matters too. Regulation 9 requires care to reflect preferences, which you cannot know without asking. Regulation 10 requires dignity and respect, which is delivered largely through how staff speak to people. The Mental Capacity Act requires all practicable steps to help someone make their own decision, which means using their communication method rather than yours. The Equality Act 2010 requires reasonable adjustments, and the Accessible Information Standard sets out exactly what must be done for people with information or communication needs related to a disability or sensory loss.

The three directions communication travels

It helps staff to see communication as three distinct jobs rather than one skill.

• With the person. Understanding them and being understood by them, on their terms.
• Within the team. Handover, records, supervision, informal chat in the corridor that should have been written down.
• Outward. Families, GPs, district nurses, hospitals, social workers, commissioners, safeguarding teams, pharmacies.

Most training covers the first. Most failures happen in the second and third.

Types of communication in care: verbal

Verbal communication is the words used and the way they are delivered: pace, volume, tone, the order information is given in, and whether the person has time to answer.

The commonest verbal errors in care are speed and complexity. Staff ask a question and answer it themselves three seconds later. They give three pieces of information in one sentence. They use service language: do you want your PRN, are you self-caring, we will refer you to SALT. For many people, especially those with a learning disability or a dementia, the fix is simple: one idea per sentence, ordinary words, a pause of at least ten seconds, and a willingness to wait through silence.

Types of communication: non-verbal

Estimates of how much meaning is carried non-verbally vary and the famous percentages are not reliable, but in care the practical point is not in doubt. Facial expression, eye contact, posture, gestures, touch, personal space, position and pace all carry meaning, and for people without speech they carry almost all of it.

Non-verbal communication runs both ways. Staff should be reading it: grimacing when moved, refusing food, rubbing a jaw, guarding a limb, going quiet, pacing, becoming clingy, sleeping more. These are often the first signs of pain or illness. Staff should also be managing their own: standing over someone in a chair, folding arms, sighing, checking a phone, talking to a colleague over a person's head during personal care. Every one of those communicates something, usually something you would not choose to say out loud.

Types of communication: written and recorded

Written communication in care includes care plans, risk assessments, daily notes, MAR charts, body maps, fluid and food charts, incident forms, handover sheets, emails to professionals, letters to families and messages between shifts.

The quality test for a written entry is whether a worker who was not there could act on it. He had a good day tells nobody anything. He was restless until his tooth was looked at, settled after 2pm and ate a full tea, means something. Our guide to daily care notes has worked examples of both.

Types of communication: formal and informal

Formal communication is the scheduled and recorded kind: handover, team meetings, supervision, reviews, professionals meetings, written records. Informal is everything else: the corridor conversation, the note on a sticky pad, the message on a staff group chat.

Informal communication is valuable and impossible to remove, but it is also where information goes to die. The rule worth teaching is simple: if it affects someone's care, it goes into the record, not just into a colleague's ear. And personal messaging apps should never carry resident information, both for data protection reasons and because nothing in them can be found again when it matters.

Specialist and alternative communication

Communicating with people with a learning disability

Jordan is 27, has a moderate learning disability and is autistic. He uses some speech, understands far more than he can say, and needs processing time. What works with him is what works with most people in his position: say one thing at a time, give real choices rather than open questions, use pictures, allow long pauses, warn before changes, and check understanding by asking him to tell you what is going to happen rather than asking whether he understands.

What fails is the closed question habit. Are you all right, Jordan? gets yes every time, because yes is the easy answer. Show me how your tummy feels, or a pain scale with faces, gets information. Our learning disability care plan examples show how to write this into a plan so a new worker can do it from day one.

Communicating with people living with dementia

Priya is 84 and has advanced dementia. She speaks Gujarati when she is tired and English when she is settled, which is common: the first language returns as the illness progresses. Her care depends on staff knowing that, and on at least some materials and some staff being able to use a few words of Gujarati.

The general principles are well established: approach from the front, get to eye level, use her name, keep sentences short, ask one question at a time, offer two choices not five, avoid testing questions such as do you remember me, do not argue with a mistaken belief, and respond to the feeling rather than the fact. If Priya is looking for her husband who died in 2009, the answer is not he died, love. It is to ask about him, sit with the feeling and redirect gently. Correcting her causes fresh grief every time.

Communicating in mental health services

Marcus is 41 and has a diagnosis of schizoaffective disorder. Communication here is less about method and more about trust and consistency. Staff should be predictable, honest about what they can and cannot do, clear about boundaries, and careful with tone during periods when he is suspicious.

Two specifics matter. First, agreed early warning signs in the person's own words, so that staff notice change rather than interpret it. Marcus stops answering his phone two or three days before he becomes unwell. Second, avoiding the trap of treating every difficult conversation as a symptom. If Marcus is angry that his leave was cancelled, he is angry because his leave was cancelled. Our guide to recording risk in mental health services covers how to document early warning signs usefully.

Barriers to communication in health and social care

Barriers are usually taught as a list to memorise. It is more useful to sort them into five groups, because each group has a different fix.

The barriers nobody writes down

Three organisational barriers do more damage than all the sensory ones combined, and they are rarely named in training.

Time. A worker with eleven people to get up before breakfast will not wait ten seconds for an answer. The barrier is the rota, not the worker.

Hierarchy. A care assistant who believes the nurse will not listen stops reporting the small things, and small things are how deterioration shows itself. Services that fix this deliberately, by thanking people for escalating and never punishing a wrong call, get earlier warnings.

Fragmented records. If medication sits in one system, daily notes in a folder and incidents in a drawer, nobody can see the whole person. That is a communication barrier built into the furniture. Keeping it in one place, as services do with a system such as Kiwi, is a communication intervention as much as an administrative one.

The Accessible Information Standard

If you provide NHS or publicly funded adult social care, the Accessible Information Standard is not optional. It requires five things for people with information or communication needs relating to a disability, impairment or sensory loss: identify the need, record it in a consistent and findable way, flag it so it is obvious whenever the record is opened, share it with others where appropriate and lawful, and meet it.

The test in practice is whether a brand new worker opening a person's record on their first shift immediately sees how that person communicates. If the information is on page nine of a care plan, you have recorded it but not flagged it, and the standard is not met.

Active listening, in concrete terms

Active listening is a phrase staff hear constantly without being told what to do differently. In practice it is six behaviours: stop the task and face the person, let them finish without completing their sentences, tolerate silence, reflect back what you heard in your own words, ask one open question, and act on it visibly so they know it landed.

The last one matters most. People stop telling staff things when nothing ever happens. If a resident says the food is always cold and nothing changes, they will not tell you about the bruise either.

Communicating with families

Families are the most common source of complaints, and almost all of those complaints start as a communication failure rather than a care failure. The pattern is familiar: something happens, nobody rings, the family finds out on a visit, and trust is gone for a year.

Four habits prevent most of it. Agree at admission who is contacted, for what, and how quickly. Ring about the small things as well as the big ones, so calls are not always bad news. Be the first to tell them when something goes wrong, which is also what duty of candour requires. Record every contact, with the date, who called, what was said and what was agreed.

Difficult conversations and duty of candour

When something has gone wrong, the instinct to soften and delay is strong and it is always a mistake. The structure that works is simple: say what happened, say what you have done, say what happens next, apologise properly without hedging, and follow up in writing.

An apology is not an admission of liability and the regulations require it. What families remember is not the incident but how they were told, and the ones who pursue complaints for years are usually the ones who felt managed rather than informed.

Communication within the team: handover

Handover is the highest-risk communication event in a care service because everything depends on it and it happens when everyone is tired. A good handover is structured, short, person by person, focused on change rather than repetition, and written down somewhere the next shift can check.

The things that must travel every time: changes in health, new or altered medicines, refusals, incidents and falls, appointments and visits, anything a professional said, anything a family raised, and anything a person said that matters. Our guide to handover structure sets out a format that takes fifteen minutes for a twenty-bed unit.

Communicating with health professionals: use SBAR

Care staff are frequently not listened to by clinicians, and a large part of the fix is in the structure of the call. SBAR gives you the shape that clinicians expect.

• Situation: I am calling about Priya Patel, 84, at Oak House. She has become drowsy and confused this afternoon.
• Background: She has advanced dementia and a history of urinary infections. She was treated for one in August. She normally walks with a frame and talks to us.
• Assessment: Her temperature is 37.9, pulse 104, she is not drinking, her urine is dark and strong smelling. Her NEWS score has gone from 0 to 4.
• Recommendation: I think she needs to be seen today. Can you visit this afternoon or should I call 111?

That call gets a different answer from she does not seem right. It also creates a record that you escalated with specifics, which matters if the outcome is poor. The same discipline applies to hospital transfers, where a current hospital passport does the communicating when staff are not there.

Recording communication needs in the care plan

Every care plan should have a communication section that a stranger could use immediately. It needs to answer: how does this person communicate, how do they say yes and no, how do they show pain, discomfort or that they have had enough, what helps, what hinders, what should you never do, and who knows them best.

Write it in the second person where you can. Give me a warning before we go out. Wait for me, I will get there. Do not finish my sentences. It reads as instruction rather than description, and a new worker follows it.

Communication when someone is distressed

Distressed behaviour is communication. The first question is never how do we stop it, it is what is this telling us. Pain, noise, hunger, boredom, fear, needing the toilet, being touched without warning, too many people, a change nobody explained: those account for the majority.

In the moment, the approach is low and slow. Reduce the audience, reduce the noise, give space, drop your voice rather than raising it, avoid standing over the person, offer one simple choice, and do not crowd. Afterwards, record what happened before, during and after, because the pattern is where the answer lives. Our guide to ABC charts shows how to capture that without writing an essay.

Confidentiality and where conversations happen

Good communication includes not communicating in the wrong place. Handover in a corridor where visitors can hear, a whiteboard with diagnoses visible from the door, a phone call about a resident taken in the lounge, a conversation about someone's continence during a meal: these are dignity breaches and often data protection breaches too.

The rule to teach is that any conversation about a person happens as though the person and their family can hear it, because often they can.

Communication and equality

Communication needs are frequently equality needs. Interpreters for people whose first language is not English, same-gender staff where culture or trauma requires it, materials in large print or braille, awareness that eye contact means different things in different cultures, and never using a child as an interpreter. Our article on equality, diversity and inclusion covers the wider duties.

How to train and assess communication skills

Classroom training on communication is almost useless on its own. What changes practice is observation and feedback.

1. Observe a worker supporting someone for ten minutes and give specific feedback: you asked three questions in a row without waiting, or you got down to her eye level and she answered you.
2. Use one real person in every supervision: how does Jordan tell you he has had enough?
3. Make communication method part of induction for every individual, not a general module.
4. Test the passports: hand a new worker a communication passport and ask them to describe how that person shows pain.
5. Include ancillary staff. The housekeeper talks to residents more than most.

What inspectors look for

Inspectors assess communication mostly by watching and by asking. They watch mealtimes and morning routines. They notice whether staff speak to people or about them, whether anybody is left out of a conversation happening in front of them, and whether people who do not speak are addressed at all.

They ask staff how a named person communicates pain. They ask whether information is available in a format the person can use. They check whether communication needs are recorded and flagged, whether interpreters are used, and whether the care plan matches what they observed. The four principles of person-centred care are largely delivered through communication, which is why weak communication shows up under Caring and Responsive at the same time.

A ten point communication audit

1. Pick three people at random. Can you find their communication needs in under a minute?
2. Ask a new or bank worker how one of them says no.
3. Sit in the lounge for twenty minutes at a busy time. Is the television on with nobody watching it?
4. Listen to a handover. Does it carry change, or repeat the same lines as last week?
5. Check whether anyone needs easy read or large print, and whether they actually have it.
6. Check that hearing aids are in and working, and that glasses are clean, at 10am.
7. Look at the last three complaints. How many began with a phone call that was not made?
8. Ask a care worker to describe their last call to a GP. Did it have structure?
9. Check whether any resident information is being passed on a personal messaging app.
10. Ask one person who uses your service what they would change about how staff talk to them.

Final conclusion

Communication in health and social care is not a soft skill bolted onto the real work. It is the mechanism by which safety, dignity and choice are actually delivered. The types are verbal, non-verbal, written, formal and informal, with specialist methods for people who need them. The barriers are environmental, sensory, cognitive, emotional and organisational, and the organisational ones are the biggest and the most fixable.

Start with three things this month: make every person's communication method visible in the first ten seconds of opening their record, put structure into handover and into calls to clinicians, and give staff permission to spend the ten seconds of silence it takes for someone to answer. Everything else follows from those.

Frequently asked

Why are communication skills important in health and social care?

Because care depends on information moving accurately between the person, the staff team, the family and other professionals. Poor communication causes missed deterioration, medication errors and diets that do not reach the kitchen. It also removes choice and dignity, since a person who cannot make themselves understood loses control of their own life, and most complaints from families begin as a communication failure rather than a care failure.

What are the main types of communication in care?

Verbal (words, tone, pace), non-verbal (facial expression, posture, gesture, touch, personal space), written (care plans, daily notes, charts, incident forms), formal (handover, meetings, reviews) and informal (corridor conversations). Alongside these sit specialist methods such as Makaton, symbols and PECS, objects of reference, now and next boards, talking mats, easy read, British Sign Language interpreters and communication passports.

What are the barriers to communication in health and social care?

They fall into five groups: environmental such as noise and lack of privacy; sensory and physical such as hearing loss, missing glasses or pain; cognitive and language such as dementia, learning disability or English as an additional language; emotional and cultural such as fear, grief or embarrassment; and organisational such as rushed rounds, heavy agency use, weak handover and fragmented records.

How do you overcome barriers to communication in a care home?

Deal with the physical basics first: hearing aids in and working, glasses on and clean, pain relieved, television off, sit at eye level in a quiet space. Then adjust the method: one idea per sentence, long pauses, pictures or easy read, a professional interpreter where needed. Then fix the organisational causes, which usually means rota continuity, structured handover and records everyone can reach.

What is the Accessible Information Standard?

It applies to NHS and publicly funded adult social care and requires services to identify a person's information and communication needs relating to a disability or sensory loss, record them consistently, flag them so they are obvious whenever the record is opened, share them appropriately, and meet them. If a new worker cannot see how someone communicates within seconds of opening the record, the flagging part is not being met.

What is SBAR and why should care staff use it?

SBAR stands for situation, background, assessment and recommendation. It is the structure clinicians expect when receiving a call. Giving the person's name and age, relevant history, specific observations such as temperature and pulse, and a clear request such as can you visit this afternoon, gets a very different response from saying that somebody does not seem right, and it creates a record that you escalated with specifics.

How should staff communicate with someone living with dementia?

Approach from the front, get to eye level, use their name, keep to one short sentence at a time, offer two choices rather than open questions, avoid testing questions such as do you remember me, and respond to the feeling rather than correcting the fact. Many people return to their first language as dementia advances, so record that and make sure some staff and some materials can meet it.

Is distressed behaviour a form of communication?

Yes, nearly always. Pain, noise, hunger, needing the toilet, fear, boredom, being touched without warning and unexplained change account for most of it. The practical response is to reduce the audience and noise, drop your voice rather than raising it, give space and offer one simple choice, then record what happened before, during and after so the pattern can be found.

Sources

• Skills for Care: Care Certificate standard 6, communication
• NHS England: Accessible Information Standard (DCB1605)
• Equality Act 2010
• Mental Capacity Act 2005 and its Code of Practice
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulations 9, 10 and 20
• NICE guideline NG97: Dementia, assessment, management and support
• Care Quality Commission: single assessment framework and quality statements
• Royal College of Speech and Language Therapists: communication access and inclusive communication