Lord Ponsonby of Shulbrede
My Lords, I open by thanking the Minister and noble Lords who are going to take part
in this important debate. It is about deaf people, by which I mean people who are born
or become profoundly deaf before the age of five. They usually prefer to communicate in
British Sign Language and see themselves as part of the deaf community. By this definition,
there are an estimated 70,000 deaf people in the United Kingdom.
I am speaking to a deaf health study called Sick of It, launched last week, on 25 March,
which is the largest and most extensive study of the health of deaf people in the world
so far. Most of the study was funded by the Big Lottery Fund and carried out by the charity
SignHealth in partnership with the University of Bristol. I am particularly indebted to
Dr Andrew Alexander, SignHealth's medical director, who provided me with the briefing
for this debate.
Before now, there has never been any research on this scale into the health of deaf people
in this country. Although there have been a few small studies
looking at access to health-all found it poor-no Government have ever specifically addressed
the health of deaf people as I have defined them here. The closest initiative was Mental
Health and Deafness-Towards Equity and Access. Although this started as a consultation on
mental health, it included a lot on the wider barriers faced by deaf people. The report
was supported by funding which was received by each primary care trust to help it implement
the recommendations of the report.
Deaf health rarely features on any agenda, with the notable exception of that of the
House of Lords. Even within health and equality programmes, attention is normally focused
on groups with a higher profile. It does not help that being deaf is a hidden disability
and that there is so little awareness of the barriers that deaf people face. This is usually
the case on the health front line as well. Most staff will think that speaking louder
or writing things down will solve the problem. When surveyed, a very high percentage of doctors
wrongly thought that they had communicated well with their deaf patients.
I turn to the report's methodology and findings. There were three stages to the report: first,
an online survey was conducted by Ipsos MORI; secondly, personal health assessments were
made of 298 deaf people, including looking at their blood pressure and BMI and taking
blood tests, et cetera; thirdly, there were in-depth interviews of deaf people. The findings
were as follows. First, underdiagnosis and undertreatment of potentially serious conditions
was more common for deaf people. Secondly, high blood pressure was almost twice as common
in deaf people as in the rest of the population. Thirdly, deaf people have generally healthier
lifestyles than the rest of the population in terms of smoking and alcohol but are more
likely to be overweight. Fourthly, there is underdiagnosis: deaf people are twice as likely
as hearing people to have high blood pressure that has not been diagnosed and may also be
more likely to have undiagnosed diabetes, high cholesterol and cardiovascular disease.
Moving on to poorer treatment, the report also found that when deaf people have been
diagnosed, they are more likely to be on inadequate treatment for those conditions. It has been
estimated that if the deaf community had the same health profile as the general population,
the NHS would save about £30 million per year.
I will now talk about access and communication. A large number of deaf people reported not
seeing their GP because they were put off by the prospect of poor communication. A large
proportion booked appointments by going to the practice in person-some 45%-whereas very
few hearing people book appointments in this way. Only 15% of deaf people said that their
GP was good at listening to them, compared to 51% of the general population. At most,
30% could use BSL in a consultation even though, in total, 94% would prefer to sign. More than
half had to use an English-based form of communication-for example, lip reading or writing notes-but
only 5% would prefer to communicate in that way. This disparity between how deaf people
have to communicate and how they would like to communicate is an indictment of the health
service, and an explanation for the poorer health outcomes of deaf people. Only 25% of
deaf people have confidence in their doctor, compared to 67% of the general population.
There is also a wider issue about access to information. Because health information is
not widely available in an accessible format, a lot of the deaf people studied were unsure
about their health and unsure what their prescriptions were for or how to take their medicine. While
many hearing patients would find out more information from friends, family or the internet,
these options were less available to deaf patients. As a result, few of the deaf people
interviewed through the in-depth process appeared actively engaged with their own personal health
management.
What are the prescriptions for change? I should just say that change from the point of view
of the deaf community is about equal rather than special treatment.
The first prescription is that systems within the health service need to be accessible.
From booking an appointment to getting test results, there should be a communication agreement
for each deaf patient, which is then coded and recorded in their patient record. Secondly,
deaf patients should be able to book appointments online and be able to use texts to communicate
with services. Thirdly, deaf patients should be able to communicate during consultations
in their preferred language. Health services must expect and plan for deaf patients. Clinicians
should remember that interpreters are not just for deaf people but help the doctor to
understand and diagnose properly. Fourthly, providers must make sure that staff know how
to book an interpreter and ensure that interpreters are suitably qualified. Fifthly, health information
needs to be made accessible in other formats, including BSL and subtitles. Currently, only
10 out of a total of 900 NHS Choices videos are available in BSL. The proposed information
standard on accessibility should be supported with a funded programme.
I move on to some questions, which I have given notice of to the Minister. First, are
there any plans to ensure that NHS Choices increases the number of videos available in
BSL? Secondly, what would the Minister recommend to a deaf person who wants to see a doctor
but is told no interpreter is available or that it is too expensive? It was brought to
my attention earlier today by Dr Clare Redstone, a GP, that it is very common to experience
problems in booking interpreters. Thirdly, what steps will the Government take to encourage
the NHS Executive and Public Health England to promote the health of deaf people? Fourthly,
when can we expect the NHS computer system to be able to tell us how many deaf people
there are and which services they are accessing? Fifthly, will implementation of the proposed
information standard be supported with a funded programme which can help to educate and support
health services?
My sixth question is one that I sent the Minister earlier regarding whether psychological therapies
providing BSL should be the responsibility of specialised commissioners. I understand
that the Minister has since decided that psychological therapies for deaf people should not be on
the list of prescribed services. Therefore, in the updated situation, my question is:
how can we ensure that psychological services nationwide are available for deaf people?
I understand that there is a very patchy covering at the moment. Lastly, what does the Minister
think would be the best way to raise deaf awareness among staff working in the health
service?
I look forward to the Minister's response. I understand that she is working on a cross-governmental
strategy on hearing loss and that the report on this is ongoing. My debate today is about
a very specific cohort within that deaf community, and I hope that she will be able to address
the questions that I have raised.
My Lords, I am grateful to the noble Lord, Lord Ponsonby, for bringing this matter to
debate following the SignHealth report.
I must, first, declare an interest. For about the past 25 years, I have been a trustee of
the Ewing Foundation for deaf children, a charity that has, for the past 60 years, helped
to improve the teaching of children who use their residual hearing and lip reading to
communicate by speech.
The change in the prospects and outcomes for deaf children due to the introduction of cochlear
implants, digital hearing aids and newborn hearing screening is one of the most exciting
stories in disability. Noble Lords may have seen the publicity in the papers on Friday,
or even the YouTube film, of the joy of a deaf girl of 40 hearing for the first time
when her cochlear implants were turned on. For the first time, she can hear music, the
laughter of babies and the songs of birds. This revolution has come from cochlear implants,
which will radically reduce the disabling effects of profound deafness in children and
adults.
The Sick of It report is important and interesting, but I am afraid that it gives away its self-selected
background. A statistic on the page about communication issues claims that 80% of deaf
people want to communicate using British Sign Language. The noble Lord suggested that that
figure was 93%, but I think it is the definition of "deaf" that accounts for the difference.
That statistic is a conundrum to me, in that the vast majority of deaf people, using a
more ordinary definition of the word, are elderly people who do not use British Sign
Language. Indeed, the CRIDE report said that 79% of deaf children use only spoken English.
It may be that the definition of deaf depends on who is hearing it.
A strong part of good communication is literacy. Unfortunately, communicating through sign
language while learning to read and write in English is like talking in English and
reading and writing in Chinese. I am filled with admiration for all the children who can
do it. Noble Lords may have strong opinions about whether tweeting and texting can really
be described as literature but they are fundamental to the lives of many teenagers nowadays. There
is some great technology coming forward. The Apple digital assistant, Siri, and many other
programs can transcribe your questions, and a doctor's replies can be sent from an iPad
to a simultaneous remote caption service. All these new technologies need literacy.
The theme of the report is that good communication is fundamental to good health, and that makes
sense, but it is true not only of deaf patients; communication with all patients can be made
better.
Another feature of the report is isolation, and deafness is very isolating. Research has
shown that in old age the combination of cognitive decline and hearing loss can be fatal. Hearing
loss seems to speed up dementia, so perhaps hearing loss in older patients should be treated
more aggressively when it is first diagnosed, and deaf awareness training given to more
health professionals.
Time after time, surveys suggest that there is a correlation between good health and good
education, so the most powerful advantage to the health of deaf people is to make sure
that they get a great education. Profoundly deaf children now, thanks to cochlear implants,
can be educated primarily in mainstream schools, with hearing friends and ordinary prospects
for the future.
But cochlear implants are expensive, although not so much in their implantation, which,
like everything electronic, is improving technically and reducing in price. The real cost comes
in training the baby or the child who needs to get the most out of their implant. However,
this is so much cheaper than a lifetime of interpreters. I must compliment all parties
for getting on with the cochlear implant programme and not stinting on this project. Ten thousand
people have had cochlear implants so far. That is a marvellous achievement and it is
changing society. There are now only a very small number of children below the age of
five who use sign language, and BSL may be regarded in the future as being used by fewer
and fewer deaf people. Who knows what will happen? Many other skills have been superseded
by technology. We will have to do our best to support those who continue to use sign
language but they will gradually become a tiny minority of deaf people.
Some 40% of deaf children have disabilities in addition to hearing loss. Deafness and
autism or deaf and blind with a learning disability are combinations that are becoming more common,
partly as a function of doctors saving extremely premature babies who in past years would have
died. These babies can now survive at 22 weeks' gestation, but with multiple problems. Some
parents are better than others at caring for a child with challenging behaviour who may
never live independently but, sadly, some children are effectively abandoned by their
parents to the state-a sad future for a child following heroic efforts to save an extremely
short pregnancy.
I have two questions for the Minister. The first concerns the reducing number, and increasing
age profile of, qualified teachers of the deaf. The report stresses the importance of
good health education for deaf people. Deaf children and young people need to be equipped
with information and strategies to access health services independently as adults. To
achieve that, we will need more teachers of the deaf. How can we get them?
The noble Baroness was asked a very similar question in a debate last October by my noble
friend Lady Brinton, and she replied with information about the national scholarship
fund. How many teachers have applied for, and how many have been granted, help from
this fund to train as teachers of the deaf? It appears that this fund is not working well
enough to solve the problem, so what else can be done to encourage more teachers to
work in this specialist area?
Secondly, can we increase the amount of communication in our health service that is duplicated both
verbally and by text? It is far cheaper to have a text system of booking appointments
than an interpreter, and that expenditure will benefit not only deaf patients but all
patients who can read and write in English.
My Lords, having seen the title of the SignHealth report, I was surprised by nothing that I
read in it. If you think about it, when you are dealing with a medical situation, being
able to tell somebody what the matter is has to be a huge advantage. Man as an animal is
supposed to be a compulsive communicator. One major thing that we do is to talk to each
other and if something gets in the way of being able to communicate properly, we will
have problems. The question is: how do we deal with that? We will never get it absolutely
right.
I have to declare an interest. I am chairman of a company called Microlink, which supports
disabled people through its innovations, usually involving computing. This has led me to take
a closer look at this area. Indeed, one of our case studies concerned being an online
interpreter. Most of us are online. It is a much better use of an interpreter's time
to be able to use British Sign Language online than it is for him or her to have to follow
a person around.
In addition, if we are supposed to be enhancing the dignity of a person, we want to give them
as much independence as possible. A translator is an expensive, difficult piece of kit you
may not want in the room when you are talking to your doctor about, for example, sexual
health or reproduction, particularly if they are there all the time. Having something online,
as described here, seems a perfectly sensible way forward but to use it both parties must
know that it is possible and how to access it. Making sure that that information is discerned
throughout the system for the client base and the provider is essential to getting the
best out of it. That must be looked at and people must know it is available. If it can
be done comparatively easily, which seems to be the case, everyone must know. That would
enhance the dignity of the patient and make the job of the doctor easier. We can go into
the night speaking about that.
As the noble Lord, Lord Borwick, has mentioned, lots of technologies are language-based. If
you are literate, you would have another means of communication. As someone who is dyslexic,
I have a little story about one of these bits of technology. Through the aforementioned
interest, I saw a wonderful piece of kit which addresses literacy and gives a person some
personal space. The UbiDuo comes from the States, although I do not think that we would
have given it that name. Basically, you use two keyboards and two screens that are roughly
the size of small computers, and you get instant translation of your communication to someone
else. They can read it and communicate back. I was shown this at a conference where everyone
else was oohing and ahing about it. I discovered that I was the only person who could not use
it because I am dyslexic, which shows that everything has its limitations. However, if
you are informed and know what is going on, you can overcome that and get through to the
other person. A line of communication can be established. There are many different types
and uses of language. If we can establish the fact that they are available and known
about, these problems will be cut.
Most of what we are talking about will cut across government departments. How would anything
being talked about here not be covered in one's health employment profile? I bumped
into Mike Penning, the disability Minister, who said that he is going to try to work across
departments. It is nice to know that disability has been slightly pushed up and now has a
Minister of State. There will be the same problems in health, employment and education.
Everything relates and cross-references. How we deal with that is very important.
When someone leaves a medical establishment, hospital or doctor's surgery, how will they
interpret the lifestyle and support that they will receive? I know Mike Penning reasonably
well and he is a tenacious individual but I do not know how much he and Ministers in
other departments can make sure that this support is followed through. If deaf people
are overweight and want healthier lifestyles, it is true that they have more trouble accessing,
for example, exercise and outdoor activity. What are we doing to make sure that they can
or that they do not have to jump over hurdles? We should be able to take our solution from
one place to another.
We have just heard a very positive description of what might happen with cochlea implants.
That will never deal with all the problems but it might deal with quite a lot of them.
However, as the noble Lord said, most people's hearing problems are probably late onset.
As with most disabilities, they build up. The deaf community has vociferous factions
within it which will tell you that true deafness is something else, that it is what they have
and not what someone else has, and that their approach and nothing else is the proper one.
They are like all other communities I have ever met in that regard. However, unless you
can get an approach which covers a variety of ways of dealing with the communication
problem, addresses all those areas and accepts that they are all equally valid, you will
always create more holes, cracks and barriers than you should otherwise have.
Finally, I have a story about the aforementioned UbiDuo. When Esther McVey was the Minister
for Disabled People, she was at a conference and decided to have a chat with the deaf man
who was doing a demonstration. After a long conversation with aides possibly tugging at
her elbow to get her out of the room, we went along and said, "This is wonderful. Isn't
it a great piece of kit?". A woman from the next stall said, "I wonder if she would have
been quite so keen if it wasn't such a tall, good-looking man on the other side". If my
honourable friend had not noticed that, the woman on the next stall certainly had. Allowing
someone to interact on a basic human level is what we are after. This is merely an application
that can be used in the healthcare that we are looking at. Unless we approach it like
that, we will miss far more opportunities to enhance people's lives overall than we
should.
My Lords, I congratulate the noble Lord, Lord Ponsonby, on securing this debate on much
needed improvements for the health needs of deaf people. Although deaf people have the
advantage, unlike the blind, of being able to see, the fact that deafness is not a visible
disability, as the noble Lord, Lord Ponsonby, has said, means that other people are not
necessarily aware that you are deaf. Therefore, less immediate attention is given in trying
to help with any problems that the person will be facing. Perhaps that lack of awareness
of deafness also helps to explain why so few Members of your Lordships' House are taking
part in this important dinner-break debate.
As someone who has had hearing problems since my children were born, and as I have now reached
the limit of what hearing aids can do to help me understand what people are saying, I have
some, although obviously not a complete, understanding of the problems and frustrations that deaf
patients face. Most definitely I have sympathy with the concerns so graphically illustrated
in the pamphlet How the Health Service is Failing Deaf People. It clearly makes sense
for doctors' surgeries or hospitals to have the kind of BSL support or other technical
arrangements to hand that the authors of this pamphlet are advocating should be routine
but clearly are not. Although I suspect that not everyone who is deaf will mind having
someone close to them speak to the doctor, the individual's wishes should be paramount.
Surely, it must be of concern to us all that so many deaf people have a considerably poorer
health record than the average citizen. I was glad to see from a Healthwatch briefing
sent to me over the weekend that a few areas of the country are beginning to realise the
extent of the problems that deaf or hard-of-hearing patients face. In 2013, Kirklees Healthwatch
followed up numerous concerns identified in its survey of the area. I hope that at least
some of these-for example, deaf awareness training being developed and rolled out for
provider staff, including handling phone calls, personal visitors and booking of BSL interpreters-are
beginning to happen. Healthwatch also reports the beginnings of awareness and action in
areas such as York, Wakefield, Staffordshire and Stockport. As well as the important reasons
in the pamphlets for the relevant help proposed, there are other reasons why a greater priority
needs to be given to those who are deaf or in the process of going deaf. Ageing, by itself,
inevitably brings hearing loss. As people are living considerably longer these days,
they will have hearing problems for a longer period of their lives. As well as that, the
way that today's young expose their ears to incredibly loud media sounds will inevitably
mean that when age kicks in, their hearing loss is bound to be considerably worse, last
longer and probably start at an earlier age.
Interestingly, in your Lordships' House, despite all the modern hearing loops that are fitted
in the Committee Rooms, which others may also have found quite difficult to communicate
with, I find that the very best hearing loops available are those that we can switch into
in the Chamber in itself-where we are at the moment. This has a great deal to do with the
considerable improvements that have recently been completed here, but I suspect that it
is also helped by the way that the microphones all hang down from the ceiling and speakers
are located in the seats of every Bench for people to listen through.
As in so many other ways, because so many noble Lords themselves are going through the
stages of ageing, including hearing loss, apart from each one of us checking that appropriate
equipment and help are available in our own doctors' surgeries-which I certainly hope
every one of us here today will do-debates such as this that seek government backing
can also help to raise awareness of the necessary action to be taken.
With that in mind, I look forward to what the Minister can tell us about what the Government
will do to reassure the noble Lord, Lord Ponsonby, about his six questions and the others that
we have added. These considerable changes must take place in doctors' surgeries and
hospitals to meet the wide range of needs described so graphically in the pamphlet,
How the Health Service Is Failing Deaf People. To continue with such failure would surely
be a disgrace.
My Lords, I am very grateful to my noble friend Lord Ponsonby for his initiative and his excellent
speech. I declare my interest as chair of an NHS foundation trust, a consultant and
trainer with Cumberlege Connections and president of GS1.
Parliamentary debates about the quality of public services to deaf people are all too
infrequent. Therefore, like the noble Baroness, Lady Howe, I welcome the opportunity to put
that right tonight. As noble Lords have said, it is particularly opportune because of the
publication on 25 March of this excellent report by the deaf health charity SignHealth.
I was very privileged to speak at the conference held on 25 March to launch the report.
As my noble friend said, the report makes very sobering reading. He went through some
of the details, but the headline results of issues in relation to deaf people in the health
service-underdiagnosis, poorer treatment, poorer communication and lack of accessible
health information-are a salutary wake-up call to us all. As the noble Baroness, Lady
Howe, said, this has been reinforced by some interesting work by local Healthwatches, which
we were sent over the weekend. The noble Baroness referred to Kirklees Healthwatch, but I also
notice work in York, Wakefield, Staffordshire, Enfield, Islington and Stockport. All of those
local Healthwatches are doing good work in their areas. I hope that the Government will
listen to what Healthwatch is saying and act on some of its recommendations and proposals.
My noble friend referred to a number of recommendations made by SignHealth to try to turn the situation
around, such as communications agreements for each deaf person coming into contact with
the health service. It is surely a sensible recommendation that they should be able to
book appointments online using SMS text to communicate with services. Also, health information
needs to be more accessible in other formats, including British Sign Language and subtitles.
Importantly, there is the recommendation on psychological therapies, which ought to be
available to deaf people in British Sign Language nationwide. It has been reported to us that
Ministers have turned that recommendation down. I would be grateful if the Minister
could update the House on that. If Ministers have turned it down, does she think that that
is consistent with the Equality Act duty? I want to ask the Minister about this more
generally. She knows that individual National Health Service bodies and the department's
arm's-length bodies have public sector equality duties under Section 149 of the Equality Act
2010. This duty requires public authorities to have due regard to eliminate discrimination
between those with and without a protected characteristic and to advance equality of
opportunity between those with and without a protected characteristic. My understanding
is that that means removing or minimising disadvantages suffered by people in protected
groups and considering steps to meet the needs of protected groups where they are different
from those of other people. Public authorities are also under a duty to make reasonable adjustments
for disabled people to make sure that a disabled person can use a service as close as reasonably
possible to the standard usually offered to non-disabled people. From the SignHealth work,
it is pretty apparent that for many deaf people that duty is not being effectively applied.
Again, what action are the Government taking to monitor the implementation of the Act's
duty and what action will they take if it is clear that public authorities are failing
in that duty? We have had some debate about the necessity
of interpreting services. I have been contacted by a general practitioner who is particularly
concerned about this issue. She tells me that there is currently confusion in the NHS about
the funding for interpreters since the reorganisation and replacement of primary care trusts by
clinical commissioning groups. My understanding is that in many parts of the country primary
care trusts funded interpreting services but, since they were abolished, there seem to be
two problems. One is that clinical commissioning groups have not always been prepared to continue
to fund those services. Secondly, there has been the issue of how GPs might obtain funding
from NHS England, which is the body that they are now in contract with, for interpreting
services within their own surgeries. I understand that, while at first some GPs were successful,
there are indications that funding is now being withdrawn. That means that GPs will
have to pay for interpreting services out of their practice expenses. Again, I would
be interested in what the Minister has to say about that.
The noble Lord, Lord Borwick, made an interesting speech and I certainly take his point about
literacy and the achievement of the cochlear implant programme. However, I was delighted
with the official recognition of British Sign Language some years ago. I recall the bad
old days when some deaf children were forbidden to use sign language at school. We have all
moved on from that and, for those deaf people who use sign language, it is important that
interpreters are available in the NHS. I also share his concern-he raised the point that
we debated in October-about whether enough people are coming forward to train as teachers
of deaf children. That is a very important point.
I very much take the point raised by the noble Lord, Lord Addington, about online interpretation.
He was really saying that that solution was capable of a much wider interpretation than
simply talking about deaf people themselves. We must surely be on the edge of a revolution
in communications and the use of IT in the health service. This could clearly bring great
advantages for many people who find communications difficult at the moment, but I do not think
it takes away the responsibility of people in the health service to improve the way they
do things now. It is very clear that some deaf people are finding services very inaccessible
indeed. I totally agree with the noble Lord: it is
another way of skinning the cat-that is all. The NHS has a long way to go to use the technology
that the noble Lord has put forward. I welcome the suggestions that he made.
My noble friend Lord Ponsonby asked the Minister a number of questions. I would like to put
forward a number of proposals for the Government to consider. For many years, the outcome of
health services for deaf people has been overlooked. We are talking about a relatively small group
of people-people who inevitably find communication difficult. Will the Government consider the
appointment of a national champion-perhaps a national clinical director-to champion health
services for deaf people? The clinical directors that the department and NHS England have taken
on have been outstanding in giving leadership in relation to a number of clinical areas.
I wonder whether, for deaf people in particular, having a champion at national level could
help disseminate information and really bang heads together to ensure that much more focus
is given to the needs of these people. Secondly, will the Minister encourage Healthwatch
to continue to build on its work to give specific focus on services for deaf people?
Thirdly, will the Minister encourage health and well-being boards at local level to pick
up our concerns about across-the-board services? The noble Lord, Lord Addington, made a very
strong point about the role of the Minister for the Disabled at national level. At local
level, the health and well-being boards could clearly carry out that same function.
Fourthly, will the Minister encourage the development of clinical networks in each local
health area so that there is co-ordination of services across primary, secondary and
tertiary care as regards the needs of deaf people?
Finally, will the Minister institute regular meetings between deaf organisations and the
NHS within each local health area so that there can be proper discussion and debate
about the needs of deaf people? This is a very important debate and I am sure
that we all look forward to a positive response from the Minister.
My Lords, I thank the noble Lord for securing this short debate on the health of deaf people,
and I welcome the opportunity to discuss the serious concerns that he raises. This has
been a really good, well informed debate and many excellent questions have been asked.
I would point out that my scripted speech is six-minutes long, so I hope to answer as
many of the other questions as possible within the rest of the time available to me. However,
in tested and time-honoured tradition, I will send a letter to all noble Lords to address
anything that I have not covered. I would also like to take this opportunity
to pay tribute to the work of SignHealth and the efforts that it has made to achieve equal
access to healthcare and better health outcomes for deaf people. The findings outlined in
its recent report, Sick of It, are truly shocking. The fact that deaf people are more likely
to have undiagnosed conditions such as high blood pressure and diabetes and that they
are more likely to receive inadequate treatment when they are diagnosed, is completely unacceptable.
This Government are committed to delivering health outcomes that are among the best in
the world for people with hearing loss. Before getting to the main issue of the health
of the deaf population, I would like to spend a few seconds outlining service improvements
to those with hearing loss or who are deaf. These include the rollout of a national screening
programme for newborn children; significantly reduced waiting times for assessment and treatment,
with almost all patients now treated within 18 weeks, with the average being four and
a half weeks; and greater choice of hearing aid services-for example, through independent
high street providers. In particular, by taking forward measures which enable the early identification
of deafness, we are able to provide a clear care pathway for services and enable parents
to make informed choices on communication needs.
However, as SignHealth's report shows, it is in the most basic way that we are failing
deaf patients. Small adjustments could make a real difference by enabling those with hearing
loss to communicate with their health providers. Have services thought about how deaf patients
can book a GP appointment if they cannot just pick up a telephone? Once they have made an
appointment, will they know when their name is called or will they be left sitting in
the waiting room? Once they get to see their GP or hospital clinician, will they be able
to communicate with them? I am sure that SignHealth would readily identify with the questions
I have posed. The noble Lord, Lord Addington, talked about
the use of technology in communication, and he brings his personal knowledge to bear.
Online signing is something that might be sensible, and an intelligent use of services
such as Skype might also be helpful. Critical to all of this-and I shall come to it later-
is the co-commissioning of these sorts of services. That sort of approach would not
only give patients their dignity but also help make the GP's job more straightforward.
The noble Baroness, Lady Howe of Idlicote, urged noble Lords to carry out checks in their
own practices. I do not think that anyone would dare not to do so after that. Certainly
with my own practice in Bodmin, in the heart of Cornwall, I can book online to see a doctor
or a nurse. When I turn up for a visit I do not talk to a receptionist, I just press a
touch-screen pad which asks me for my date of birth and my gender. It then says, "Ah!
Are you Mrs Jolly?", and tells me to sit down and wait. All those services would work perfectly
well with deaf people and there is no reason why they should not be replicated throughout
the land. What happens behind the consulting room door may not be as good as all of that-I
just do not know. There are currently over 10 million adults
in England living with hearing loss; the World Health Organisation estimates that by 2030
the figure will rise to 14.5 million. It is therefore vital that health and social care
services are geared up to be able to communicate with deaf people and those with hearing loss
in order to promote good health and address their health needs. All options should be
considered. The noble Lord, Lord Hunt, told the House about the public sector equality
duty. This requires all public bodies, including those who provide health and social care,
to, "advance equality of opportunity" and to,
"have due regard to the need to eliminate discrimination".
SignHealth's Sick of It report is right to remind deaf people that they have a right
to complain when a service provider has not taken their particular needs into account.
However, it is up to the service providers to anticipate the requirements of disabled
people and the reasonable adjustments that may have to be made for them in advance, before
any disabled person attempts to access their service. The reasonable-adjustment duty is
an anticipatory duty, so it is just not acceptable for health services not to be equipped to
provide communication support for those who need it. This may involve the use of British
Sign Language, but it may also involve the use of basic technology such as display screens
in GP waiting rooms. It may also involve something as simple as text messaging-nearly all noble
Lords referred to that-as all of us become increasingly reliant upon this and other electronic
forms of communication. My noble friend Lord Borwick talked about
skills possibly being superseded by technology and referred to cochlear implants, texts and
the internet. I defy any noble Lord not to be touched by the moving story of Joanne Milne
as she heard for the first time this week but a lot of this will take a long time to
roll out. It will take a while before the youngsters reach the age of older people who
are deaf or have hearing loss. This will not be an instant fix.
I am happy to be able to report that progress is being made on the NHS information standard.
As part of the commitment to improve the experience of patients using NHS services and empower
people to be equal partners in their own care, NHS England is developing an information standard
for the provision of accessible, personalised information. The standard will ensure that
disabled patients, service users and carers receive information from NHS bodies and providers
of NHS care in formats that they can understand. It also requires that they receive appropriate
support to enable them to communicate with service providers. Successful implementation
of this information standard will improve the health outcomes and experience of disabled
people. It will also reduce the number of appointments and screening opportunities missed
by patients who have received invitations or information in formats that are inappropriate
for them. It is intended that the standard will be finalised in late 2014, with organisations
required to comply in 2015. Alongside the statutory information standard, NHS England
will publish guidance on making reasonable adjustments to meet the communication needs
of service users with disabilities. We know that there is a need to improve both
the commissioning and integration of health and social care services for people with hearing
loss, as well as the provision of new and innovative models of care. This is why we
are also developing a new action plan on hearing loss. The action plan will identify the key
actions that will make a real difference to health and social care outcomes for children,
young people and adults with hearing loss. NHS England is currently engaging with a range
of stakeholders, including the Department of Health, Public Health England, other government
departments and agencies and key stakeholders, and aims to publish the action plan as soon
as possible.
I hope that I have been able to reassure the House that the Government have a strong commitment
to promoting the needs of deaf people across a range of public services but, in particular,
ensuring that deaf people have equal access to health and social care and improved outcomes
equal to people who do not have hearing loss. Equality is the watchword.
To answer noble Lords' questions, the noble Lord, Lord Hunt, asked about the decision
on psychological therapy provided in British Sign Language and where the responsibility
for that should be in specialised commissioning. Following advice from the prescribed specialised
services advisory group, and in consultation with NHS England, Ministers have taken the
decision that responsibility for commissioning psychological therapies for deaf sign language
users should remain with the clinical commissioning groups.
The noble Lord, Lord Hunt, also made five points. There was that of the national champion
and how to build on the work thus far. I am happy to take that back and will write to
him. On health and well-being boards, they should pick up across-the-board services.
We hope that they are doing so. I suspect that health and well-being boards will, in
their second report for this coming year, pick up on that sort of thing if they are
not doing so already. On co-ordination of services, again, it should be within the gift
of health and well-being boards to ensure that social care and all health services are
not only properly commissioned but also properly co-ordinated. It sounds an admirable idea
that there should be regular meetings with the NHS in each local area for people with
hearing loss and deafness. I imagine many people with other sorts of disability would
like to see that as well. Perhaps that is something that Healthwatch might be able to
facilitate.
Do GPs have to pay for their translation services? Each provider of a public service is responsible
for ensuring that they make reasonable adjustments to meet the needs of disabled people. This
is not funded centrally but must be found from within local budgets.
The noble Lord, Lord Addington, asked about co-ordinating help for deaf people in other
fields, such as education and employment. The Minister of State for Disabled People,
in his capacity as chair of the interdepartmental group on disability, recently wrote to Ministers
in other government departments to ask what their departments are doing to support their
deaf users. On the questions of the noble Lord, Lord Ponsonby,
about plans to ensure that NHS Choices increases the number of videos available in BSL, NHS
Choices is very keen to provide more BSL content. It has approached SignHealth and in turn secured
funding for the existing BSL videos. Noble Lords might be interested to know that there
are videos available on: breast cancer, diabetes, heart disease, lung cancer, prostate cancer,
back pain, depression and low mood, getting tested for Chlamydia, preventing high cholesterol
and tinnitus. Those are the ones currently signed.
What would the Minister recommend to a deaf person who wants to see a doctor but is told
that no interpreter is available? We recommend that they lodge a formal complaint with the
GP practice. If the complaint is not resolved, we recommend that the complaint is escalated
to CCG or NHS England as set out in the complaints procedure.
What does the Minister think would be the best way to raise deaf awareness among staff
working in the health service? It is ultimately the responsibility of individual employers
to support the development of the staff they employ. However, Health Education England
will provide leadership and work with local education training boards-LETBs-regulatory
bodies and health care providers to ensure professional and personal development continues
beyond the end of formal training.
What steps will the Government take to encourage NHS England and Public Health England to promote
the health of deaf people? The NHS is a universal service for the people of England and NHS
England is under specific legal duties in relation to tackling health inequalities and
advancing equality. The Government will hold NHS England to account for how well it discharges
these duties.
Can we expect NHS computer systems to be able to tell us how many deaf people there are
and which services they are accessing? The short answer is regrettably no, not yet. However,
the new system being commissioned by NHS England to upgrade the hospital episodes statistics-the
HES service-will mean that they include a richer source of hospital data, plus data
from care provided outside hospital. While this will not tell us how many deaf people
there are, it will tell us about deaf people's access of services. I am sure other improvements
to care data in time will be able to give us the number of deaf people there are.
Will implementation of the proposed information standard be supported by a funded programme
which can help to educate and support? As part of the engagement activity, we asked
health and care professionals and organisations to advise us as to the challenges they experience
in meeting the communication needs of patients, carers and services users, as well as the
ways they have identified to overcome the challenges. These will be reviewed. The intention
is that the findings will inform the drafting of the standard itself and the development
of supporting tools. Regarding the psychological therapies question, following a device from
the prescribed specialised services group, Ministers have decided that these services
should be commissioned by CCGs.
I move on to the question of the noble Lord, Lord Borwick: what can be done to encourage
more teachers to work in this specialist area? Schools and local authorities are responsible
for assessing their workforce and have adequate recruitment and training strategies in place.
We expect authorities to work with schools so that they know and build the appropriate
skills for the teaching workforce, and the DfE is funding scholarships for teachers to
develop their knowledge and skills, including postgraduate qualifications. Regarding the
question of texting information, this sort of thing is a local decision. I have told
noble Lords how my local GP practice chose to sort it, and others may choose to use texts.
On teacher numbers, so far 600 teachers have achieved or are working towards a qualification
relating to special education needs, and a further 500 have applied for the current funding
round. I have exhausted the supply of responses from the Dispatch Box, but I feel absolutely
sure that when we go through Hansard, many more questions that will come to light, so
we will write a letter to all noble Lords who have taken part in the debate.