This article starts by emphasising that communication failures are a fairly common cause of medical errors. They highlight that people with dysarthria can experience significant communication difficulties and are at particular risk of this type of breakdown in care. People with pre-existing dysarthria caused by progressive conditions may be excluded from end-of-life discussions, or placed in inappropriate facilities. People with recent onset dysarthria may experience significant frustration and dissatisfaction. People may not receive timely referrals for communication support during anticipated interventions (such as surgery) that will affect their communication and finally individual’s legal rights may be overlooked. Having appropriate systems in place in anticipation can avoid these issues in the first instance. The authors describe the value of having standard orders or flags for SLT referral for people with pre-existing dysarthria. They suggest having routine SLT referrals on diagnosis of a condition such as stroke or TBI, or during pre-surgery procedures for planned tracheostomy etc. They advocate for policy changes and care pathways for vulnerable people with communication difficulties. Bearing in mind the forthcoming NICE SCIE guideline on decision making and mental capacity, this article provides a timely reminder of the value of communication in daily care and decision making in the healthcare setting.