1 00:00:03,070 --> 00:00:06,899 Lord Ponsonby of Shulbrede 2 00:00:18,000 --> 00:00:23,400 My Lords, I open by thanking the Minister and noble Lords who are going to take part 3 00:00:23,609 --> 00:00:30,609 in this important debate. It is about deaf people, by which I mean people who are born 4 00:00:31,660 --> 00:00:38,660 or become profoundly deaf before the age of five. They usually prefer to communicate in 5 00:00:39,420 --> 00:00:46,420 British Sign Language and see themselves as part of the deaf community. By this definition, 6 00:00:47,149 --> 00:00:52,640 there are an estimated 70,000 deaf people in the United Kingdom. 7 00:00:52,640 --> 00:00:59,640 I am speaking to a deaf health study called Sick of It, launched last week, on 25 March, 8 00:01:04,610 --> 00:01:09,310 which is the largest and most extensive study of the health of deaf people in the world 9 00:01:09,310 --> 00:01:16,170 so far. Most of the study was funded by the Big Lottery Fund and carried out by the charity 10 00:01:16,170 --> 00:01:21,700 SignHealth in partnership with the University of Bristol. I am particularly indebted to 11 00:01:21,700 --> 00:01:26,650 Dr Andrew Alexander, SignHealth's medical director, who provided me with the briefing 12 00:01:26,650 --> 00:01:29,360 for this debate. 13 00:01:29,360 --> 00:01:34,470 Before now, there has never been any research on this scale into the health of deaf people 14 00:01:34,470 --> 00:01:37,090 in this country. Although there have been a few small studies 15 00:01:37,090 --> 00:01:44,090 looking at access to health-all found it poor-no Government have ever specifically addressed 16 00:01:45,610 --> 00:01:51,560 the health of deaf people as I have defined them here. The closest initiative was Mental 17 00:01:51,560 --> 00:01:57,590 Health and Deafness-Towards Equity and Access. Although this started as a consultation on 18 00:01:57,590 --> 00:02:03,399 mental health, it included a lot on the wider barriers faced by deaf people. The report 19 00:02:03,399 --> 00:02:09,470 was supported by funding which was received by each primary care trust to help it implement 20 00:02:09,470 --> 00:02:13,580 the recommendations of the report. 21 00:02:13,580 --> 00:02:20,580 Deaf health rarely features on any agenda, with the notable exception of that of the 22 00:02:20,690 --> 00:02:25,050 House of Lords. Even within health and equality programmes, attention is normally focused 23 00:02:25,050 --> 00:02:30,640 on groups with a higher profile. It does not help that being deaf is a hidden disability 24 00:02:30,640 --> 00:02:37,430 and that there is so little awareness of the barriers that deaf people face. This is usually 25 00:02:37,430 --> 00:02:43,420 the case on the health front line as well. Most staff will think that speaking louder 26 00:02:43,420 --> 00:02:49,890 or writing things down will solve the problem. When surveyed, a very high percentage of doctors 27 00:02:49,890 --> 00:02:54,390 wrongly thought that they had communicated well with their deaf patients. 28 00:02:54,390 --> 00:03:01,390 I turn to the report's methodology and findings. There were three stages to the report: first, 29 00:03:01,610 --> 00:03:08,610 an online survey was conducted by Ipsos MORI; secondly, personal health assessments were 30 00:03:09,100 --> 00:03:15,620 made of 298 deaf people, including looking at their blood pressure and BMI and taking 31 00:03:15,620 --> 00:03:22,500 blood tests, et cetera; thirdly, there were in-depth interviews of deaf people. The findings 32 00:03:22,500 --> 00:03:28,740 were as follows. First, underdiagnosis and undertreatment of potentially serious conditions 33 00:03:28,740 --> 00:03:35,660 was more common for deaf people. Secondly, high blood pressure was almost twice as common 34 00:03:35,660 --> 00:03:41,850 in deaf people as in the rest of the population. Thirdly, deaf people have generally healthier 35 00:03:41,850 --> 00:03:46,540 lifestyles than the rest of the population in terms of smoking and alcohol but are more 36 00:03:46,540 --> 00:03:53,480 likely to be overweight. Fourthly, there is underdiagnosis: deaf people are twice as likely 37 00:03:53,480 --> 00:03:58,760 as hearing people to have high blood pressure that has not been diagnosed and may also be 38 00:03:58,760 --> 00:04:05,760 more likely to have undiagnosed diabetes, high cholesterol and cardiovascular disease. 39 00:04:06,680 --> 00:04:12,230 Moving on to poorer treatment, the report also found that when deaf people have been 40 00:04:12,230 --> 00:04:18,940 diagnosed, they are more likely to be on inadequate treatment for those conditions. It has been 41 00:04:18,940 --> 00:04:25,310 estimated that if the deaf community had the same health profile as the general population, 42 00:04:25,310 --> 00:04:28,900 the NHS would save about £30 million per year. 43 00:04:28,900 --> 00:04:35,900 I will now talk about access and communication. A large number of deaf people reported not 44 00:04:36,480 --> 00:04:43,090 seeing their GP because they were put off by the prospect of poor communication. A large 45 00:04:43,090 --> 00:04:49,340 proportion booked appointments by going to the practice in person-some 45%-whereas very 46 00:04:49,340 --> 00:04:55,900 few hearing people book appointments in this way. Only 15% of deaf people said that their 47 00:04:55,900 --> 00:05:02,270 GP was good at listening to them, compared to 51% of the general population. At most, 48 00:05:02,270 --> 00:05:09,270 30% could use BSL in a consultation even though, in total, 94% would prefer to sign. More than 49 00:05:09,510 --> 00:05:15,610 half had to use an English-based form of communication-for example, lip reading or writing notes-but 50 00:05:15,610 --> 00:05:22,610 only 5% would prefer to communicate in that way. This disparity between how deaf people 51 00:05:23,430 --> 00:05:28,680 have to communicate and how they would like to communicate is an indictment of the health 52 00:05:28,680 --> 00:05:35,680 service, and an explanation for the poorer health outcomes of deaf people. Only 25% of 53 00:05:36,330 --> 00:05:42,890 deaf people have confidence in their doctor, compared to 67% of the general population. 54 00:05:42,890 --> 00:05:49,570 There is also a wider issue about access to information. Because health information is 55 00:05:49,570 --> 00:05:56,250 not widely available in an accessible format, a lot of the deaf people studied were unsure 56 00:05:56,250 --> 00:06:02,970 about their health and unsure what their prescriptions were for or how to take their medicine. While 57 00:06:02,970 --> 00:06:08,060 many hearing patients would find out more information from friends, family or the internet, 58 00:06:08,060 --> 00:06:13,950 these options were less available to deaf patients. As a result, few of the deaf people 59 00:06:13,950 --> 00:06:20,800 interviewed through the in-depth process appeared actively engaged with their own personal health 60 00:06:20,800 --> 00:06:24,530 management. 61 00:06:24,530 --> 00:06:30,490 What are the prescriptions for change? I should just say that change from the point of view 62 00:06:30,490 --> 00:06:36,430 of the deaf community is about equal rather than special treatment. 63 00:06:36,430 --> 00:06:41,430 The first prescription is that systems within the health service need to be accessible. 64 00:06:41,430 --> 00:06:45,870 From booking an appointment to getting test results, there should be a communication agreement 65 00:06:45,870 --> 00:06:52,710 for each deaf patient, which is then coded and recorded in their patient record. Secondly, 66 00:06:52,710 --> 00:06:58,240 deaf patients should be able to book appointments online and be able to use texts to communicate 67 00:06:58,240 --> 00:07:03,300 with services. Thirdly, deaf patients should be able to communicate during consultations 68 00:07:03,300 --> 00:07:10,300 in their preferred language. Health services must expect and plan for deaf patients. Clinicians 69 00:07:14,810 --> 00:07:20,530 should remember that interpreters are not just for deaf people but help the doctor to 70 00:07:20,530 --> 00:07:26,930 understand and diagnose properly. Fourthly, providers must make sure that staff know how 71 00:07:26,930 --> 00:07:32,840 to book an interpreter and ensure that interpreters are suitably qualified. Fifthly, health information 72 00:07:32,840 --> 00:07:38,680 needs to be made accessible in other formats, including BSL and subtitles. Currently, only 73 00:07:38,680 --> 00:07:45,680 10 out of a total of 900 NHS Choices videos are available in BSL. The proposed information 74 00:07:46,840 --> 00:07:51,830 standard on accessibility should be supported with a funded programme. 75 00:07:51,830 --> 00:07:58,240 I move on to some questions, which I have given notice of to the Minister. First, are 76 00:07:58,240 --> 00:08:03,560 there any plans to ensure that NHS Choices increases the number of videos available in 77 00:08:03,560 --> 00:08:10,560 BSL? Secondly, what would the Minister recommend to a deaf person who wants to see a doctor 78 00:08:11,669 --> 00:08:17,889 but is told no interpreter is available or that it is too expensive? It was brought to 79 00:08:17,889 --> 00:08:24,889 my attention earlier today by Dr Clare Redstone, a GP, that it is very common to experience 80 00:08:26,110 --> 00:08:33,110 problems in booking interpreters. Thirdly, what steps will the Government take to encourage 81 00:08:33,630 --> 00:08:40,549 the NHS Executive and Public Health England to promote the health of deaf people? Fourthly, 82 00:08:40,549 --> 00:08:46,060 when can we expect the NHS computer system to be able to tell us how many deaf people 83 00:08:46,060 --> 00:08:53,060 there are and which services they are accessing? Fifthly, will implementation of the proposed 84 00:08:53,150 --> 00:08:59,390 information standard be supported with a funded programme which can help to educate and support 85 00:08:59,390 --> 00:09:02,150 health services? 86 00:09:02,150 --> 00:09:09,150 My sixth question is one that I sent the Minister earlier regarding whether psychological therapies 87 00:09:15,820 --> 00:09:21,560 providing BSL should be the responsibility of specialised commissioners. I understand 88 00:09:21,560 --> 00:09:26,940 that the Minister has since decided that psychological therapies for deaf people should not be on 89 00:09:26,940 --> 00:09:33,279 the list of prescribed services. Therefore, in the updated situation, my question is: 90 00:09:33,279 --> 00:09:39,290 how can we ensure that psychological services nationwide are available for deaf people? 91 00:09:39,290 --> 00:09:46,290 I understand that there is a very patchy covering at the moment. Lastly, what does the Minister 92 00:09:49,960 --> 00:09:56,040 think would be the best way to raise deaf awareness among staff working in the health 93 00:09:56,040 --> 00:09:56,410 service? 94 00:09:56,410 --> 00:10:03,410 I look forward to the Minister's response. I understand that she is working on a cross-governmental 95 00:10:04,540 --> 00:10:11,540 strategy on hearing loss and that the report on this is ongoing. My debate today is about 96 00:10:13,610 --> 00:10:19,270 a very specific cohort within that deaf community, and I hope that she will be able to address 97 00:10:19,270 --> 00:10:23,260 the questions that I have raised. 98 00:10:23,260 --> 00:10:28,380 My Lords, I am grateful to the noble Lord, Lord Ponsonby, for bringing this matter to 99 00:10:28,380 --> 00:10:32,690 debate following the SignHealth report. 100 00:10:32,690 --> 00:10:38,700 I must, first, declare an interest. For about the past 25 years, I have been a trustee of 101 00:10:38,700 --> 00:10:44,940 the Ewing Foundation for deaf children, a charity that has, for the past 60 years, helped 102 00:10:44,940 --> 00:10:49,510 to improve the teaching of children who use their residual hearing and lip reading to 103 00:10:49,510 --> 00:10:52,620 communicate by speech. 104 00:10:52,620 --> 00:10:58,589 The change in the prospects and outcomes for deaf children due to the introduction of cochlear 105 00:10:58,589 --> 00:11:03,270 implants, digital hearing aids and newborn hearing screening is one of the most exciting 106 00:11:03,270 --> 00:11:08,870 stories in disability. Noble Lords may have seen the publicity in the papers on Friday, 107 00:11:08,870 --> 00:11:14,740 or even the YouTube film, of the joy of a deaf girl of 40 hearing for the first time 108 00:11:14,740 --> 00:11:20,690 when her cochlear implants were turned on. For the first time, she can hear music, the 109 00:11:20,690 --> 00:11:26,220 laughter of babies and the songs of birds. This revolution has come from cochlear implants, 110 00:11:26,220 --> 00:11:31,899 which will radically reduce the disabling effects of profound deafness in children and 111 00:11:31,899 --> 00:11:32,810 adults. 112 00:11:32,810 --> 00:11:38,620 The Sick of It report is important and interesting, but I am afraid that it gives away its self-selected 113 00:11:38,620 --> 00:11:45,050 background. A statistic on the page about communication issues claims that 80% of deaf 114 00:11:45,050 --> 00:11:49,660 people want to communicate using British Sign Language. The noble Lord suggested that that 115 00:11:49,660 --> 00:11:56,440 figure was 93%, but I think it is the definition of "deaf" that accounts for the difference. 116 00:11:56,440 --> 00:12:01,620 That statistic is a conundrum to me, in that the vast majority of deaf people, using a 117 00:12:01,620 --> 00:12:07,920 more ordinary definition of the word, are elderly people who do not use British Sign 118 00:12:07,920 --> 00:12:14,920 Language. Indeed, the CRIDE report said that 79% of deaf children use only spoken English. 119 00:12:16,040 --> 00:12:20,399 It may be that the definition of deaf depends on who is hearing it. 120 00:12:20,399 --> 00:12:27,399 A strong part of good communication is literacy. Unfortunately, communicating through sign 121 00:12:27,970 --> 00:12:33,770 language while learning to read and write in English is like talking in English and 122 00:12:33,770 --> 00:12:40,770 reading and writing in Chinese. I am filled with admiration for all the children who can 123 00:12:41,060 --> 00:12:47,220 do it. Noble Lords may have strong opinions about whether tweeting and texting can really 124 00:12:47,220 --> 00:12:53,959 be described as literature but they are fundamental to the lives of many teenagers nowadays. There 125 00:12:53,959 --> 00:12:59,350 is some great technology coming forward. The Apple digital assistant, Siri, and many other 126 00:12:59,350 --> 00:13:06,070 programs can transcribe your questions, and a doctor's replies can be sent from an iPad 127 00:13:06,070 --> 00:13:13,070 to a simultaneous remote caption service. All these new technologies need literacy. 128 00:13:14,320 --> 00:13:20,110 The theme of the report is that good communication is fundamental to good health, and that makes 129 00:13:20,110 --> 00:13:26,240 sense, but it is true not only of deaf patients; communication with all patients can be made 130 00:13:26,240 --> 00:13:28,580 better. 131 00:13:28,580 --> 00:13:34,970 Another feature of the report is isolation, and deafness is very isolating. Research has 132 00:13:34,970 --> 00:13:41,970 shown that in old age the combination of cognitive decline and hearing loss can be fatal. Hearing 133 00:13:44,350 --> 00:13:49,580 loss seems to speed up dementia, so perhaps hearing loss in older patients should be treated 134 00:13:49,580 --> 00:13:54,580 more aggressively when it is first diagnosed, and deaf awareness training given to more 135 00:13:54,580 --> 00:13:59,440 health professionals. 136 00:13:59,440 --> 00:14:04,120 Time after time, surveys suggest that there is a correlation between good health and good 137 00:14:04,120 --> 00:14:09,500 education, so the most powerful advantage to the health of deaf people is to make sure 138 00:14:09,500 --> 00:14:16,500 that they get a great education. Profoundly deaf children now, thanks to cochlear implants, 139 00:14:17,720 --> 00:14:23,330 can be educated primarily in mainstream schools, with hearing friends and ordinary prospects 140 00:14:23,330 --> 00:14:25,519 for the future. 141 00:14:25,519 --> 00:14:31,970 But cochlear implants are expensive, although not so much in their implantation, which, 142 00:14:31,970 --> 00:14:38,019 like everything electronic, is improving technically and reducing in price. The real cost comes 143 00:14:38,019 --> 00:14:44,860 in training the baby or the child who needs to get the most out of their implant. However, 144 00:14:44,860 --> 00:14:50,430 this is so much cheaper than a lifetime of interpreters. I must compliment all parties 145 00:14:50,430 --> 00:14:55,839 for getting on with the cochlear implant programme and not stinting on this project. Ten thousand 146 00:14:55,839 --> 00:15:00,310 people have had cochlear implants so far. That is a marvellous achievement and it is 147 00:15:00,310 --> 00:15:05,330 changing society. There are now only a very small number of children below the age of 148 00:15:05,330 --> 00:15:11,779 five who use sign language, and BSL may be regarded in the future as being used by fewer 149 00:15:11,779 --> 00:15:17,610 and fewer deaf people. Who knows what will happen? Many other skills have been superseded 150 00:15:17,610 --> 00:15:22,709 by technology. We will have to do our best to support those who continue to use sign 151 00:15:22,709 --> 00:15:29,709 language but they will gradually become a tiny minority of deaf people. 152 00:15:30,250 --> 00:15:36,899 Some 40% of deaf children have disabilities in addition to hearing loss. Deafness and 153 00:15:36,899 --> 00:15:43,899 autism or deaf and blind with a learning disability are combinations that are becoming more common, 154 00:15:44,010 --> 00:15:51,010 partly as a function of doctors saving extremely premature babies who in past years would have 155 00:15:51,130 --> 00:15:58,130 died. These babies can now survive at 22 weeks' gestation, but with multiple problems. Some 156 00:15:58,230 --> 00:16:03,700 parents are better than others at caring for a child with challenging behaviour who may 157 00:16:03,700 --> 00:16:10,700 never live independently but, sadly, some children are effectively abandoned by their 158 00:16:10,920 --> 00:16:17,920 parents to the state-a sad future for a child following heroic efforts to save an extremely 159 00:16:18,279 --> 00:16:21,269 short pregnancy. 160 00:16:21,269 --> 00:16:27,640 I have two questions for the Minister. The first concerns the reducing number, and increasing 161 00:16:27,640 --> 00:16:33,320 age profile of, qualified teachers of the deaf. The report stresses the importance of 162 00:16:33,320 --> 00:16:37,720 good health education for deaf people. Deaf children and young people need to be equipped 163 00:16:37,720 --> 00:16:43,870 with information and strategies to access health services independently as adults. To 164 00:16:43,870 --> 00:16:50,589 achieve that, we will need more teachers of the deaf. How can we get them? 165 00:16:50,589 --> 00:16:54,910 The noble Baroness was asked a very similar question in a debate last October by my noble 166 00:16:54,910 --> 00:16:58,839 friend Lady Brinton, and she replied with information about the national scholarship 167 00:16:58,839 --> 00:17:05,079 fund. How many teachers have applied for, and how many have been granted, help from 168 00:17:05,079 --> 00:17:11,749 this fund to train as teachers of the deaf? It appears that this fund is not working well 169 00:17:11,749 --> 00:17:17,339 enough to solve the problem, so what else can be done to encourage more teachers to 170 00:17:17,339 --> 00:17:20,220 work in this specialist area? 171 00:17:20,220 --> 00:17:26,769 Secondly, can we increase the amount of communication in our health service that is duplicated both 172 00:17:26,769 --> 00:17:33,600 verbally and by text? It is far cheaper to have a text system of booking appointments 173 00:17:33,600 --> 00:17:39,109 than an interpreter, and that expenditure will benefit not only deaf patients but all 174 00:17:39,109 --> 00:17:43,749 patients who can read and write in English. 175 00:17:43,749 --> 00:17:50,749 My Lords, having seen the title of the SignHealth report, I was surprised by nothing that I 176 00:17:54,009 --> 00:17:56,720 read in it. If you think about it, when you are dealing with a medical situation, being 177 00:17:56,720 --> 00:18:03,720 able to tell somebody what the matter is has to be a huge advantage. Man as an animal is 178 00:18:10,970 --> 00:18:15,429 supposed to be a compulsive communicator. One major thing that we do is to talk to each 179 00:18:15,429 --> 00:18:19,549 other and if something gets in the way of being able to communicate properly, we will 180 00:18:19,549 --> 00:18:26,549 have problems. The question is: how do we deal with that? We will never get it absolutely 181 00:18:27,090 --> 00:18:30,119 right. 182 00:18:30,119 --> 00:18:37,119 I have to declare an interest. I am chairman of a company called Microlink, which supports 183 00:18:37,720 --> 00:18:43,119 disabled people through its innovations, usually involving computing. This has led me to take 184 00:18:43,119 --> 00:18:48,179 a closer look at this area. Indeed, one of our case studies concerned being an online 185 00:18:48,179 --> 00:18:55,179 interpreter. Most of us are online. It is a much better use of an interpreter's time 186 00:18:56,919 --> 00:18:59,679 to be able to use British Sign Language online than it is for him or her to have to follow 187 00:18:59,679 --> 00:19:02,369 a person around. 188 00:19:02,369 --> 00:19:08,059 In addition, if we are supposed to be enhancing the dignity of a person, we want to give them 189 00:19:08,059 --> 00:19:15,059 as much independence as possible. A translator is an expensive, difficult piece of kit you 190 00:19:15,519 --> 00:19:22,049 may not want in the room when you are talking to your doctor about, for example, sexual 191 00:19:22,049 --> 00:19:29,049 health or reproduction, particularly if they are there all the time. Having something online, 192 00:19:29,989 --> 00:19:36,989 as described here, seems a perfectly sensible way forward but to use it both parties must 193 00:19:39,039 --> 00:19:45,090 know that it is possible and how to access it. Making sure that that information is discerned 194 00:19:45,090 --> 00:19:51,600 throughout the system for the client base and the provider is essential to getting the 195 00:19:51,600 --> 00:19:58,600 best out of it. That must be looked at and people must know it is available. If it can 196 00:20:00,720 --> 00:20:07,330 be done comparatively easily, which seems to be the case, everyone must know. That would 197 00:20:07,330 --> 00:20:13,590 enhance the dignity of the patient and make the job of the doctor easier. We can go into 198 00:20:13,590 --> 00:20:15,139 the night speaking about that. 199 00:20:15,139 --> 00:20:22,139 As the noble Lord, Lord Borwick, has mentioned, lots of technologies are language-based. If 200 00:20:22,950 --> 00:20:29,950 you are literate, you would have another means of communication. As someone who is dyslexic, 201 00:20:32,019 --> 00:20:39,019 I have a little story about one of these bits of technology. Through the aforementioned 202 00:20:43,720 --> 00:20:50,720 interest, I saw a wonderful piece of kit which addresses literacy and gives a person some 203 00:20:51,759 --> 00:20:54,899 personal space. The UbiDuo comes from the States, although I do not think that we would 204 00:20:54,899 --> 00:20:57,970 have given it that name. Basically, you use two keyboards and two screens that are roughly 205 00:20:57,970 --> 00:21:04,970 the size of small computers, and you get instant translation of your communication to someone 206 00:21:06,389 --> 00:21:12,350 else. They can read it and communicate back. I was shown this at a conference where everyone 207 00:21:12,350 --> 00:21:16,309 else was oohing and ahing about it. I discovered that I was the only person who could not use 208 00:21:16,309 --> 00:21:23,019 it because I am dyslexic, which shows that everything has its limitations. However, if 209 00:21:23,019 --> 00:21:29,909 you are informed and know what is going on, you can overcome that and get through to the 210 00:21:29,909 --> 00:21:35,059 other person. A line of communication can be established. There are many different types 211 00:21:35,059 --> 00:21:40,220 and uses of language. If we can establish the fact that they are available and known 212 00:21:40,220 --> 00:21:46,029 about, these problems will be cut. 213 00:21:46,029 --> 00:21:53,029 Most of what we are talking about will cut across government departments. How would anything 214 00:21:54,379 --> 00:22:00,649 being talked about here not be covered in one's health employment profile? I bumped 215 00:22:00,649 --> 00:22:04,239 into Mike Penning, the disability Minister, who said that he is going to try to work across 216 00:22:04,239 --> 00:22:10,720 departments. It is nice to know that disability has been slightly pushed up and now has a 217 00:22:10,720 --> 00:22:17,720 Minister of State. There will be the same problems in health, employment and education. 218 00:22:21,759 --> 00:22:28,759 Everything relates and cross-references. How we deal with that is very important. 219 00:22:29,899 --> 00:22:36,899 When someone leaves a medical establishment, hospital or doctor's surgery, how will they 220 00:22:43,450 --> 00:22:50,450 interpret the lifestyle and support that they will receive? I know Mike Penning reasonably 221 00:22:50,489 --> 00:22:56,799 well and he is a tenacious individual but I do not know how much he and Ministers in 222 00:22:56,799 --> 00:23:02,440 other departments can make sure that this support is followed through. If deaf people 223 00:23:02,440 --> 00:23:08,489 are overweight and want healthier lifestyles, it is true that they have more trouble accessing, 224 00:23:08,489 --> 00:23:15,369 for example, exercise and outdoor activity. What are we doing to make sure that they can 225 00:23:15,369 --> 00:23:22,369 or that they do not have to jump over hurdles? We should be able to take our solution from 226 00:23:22,840 --> 00:23:25,799 one place to another. 227 00:23:25,799 --> 00:23:32,799 We have just heard a very positive description of what might happen with cochlea implants. 228 00:23:32,820 --> 00:23:37,879 That will never deal with all the problems but it might deal with quite a lot of them. 229 00:23:37,879 --> 00:23:44,879 However, as the noble Lord said, most people's hearing problems are probably late onset. 230 00:23:46,749 --> 00:23:53,749 As with most disabilities, they build up. The deaf community has vociferous factions 231 00:23:54,830 --> 00:23:59,609 within it which will tell you that true deafness is something else, that it is what they have 232 00:23:59,609 --> 00:24:03,440 and not what someone else has, and that their approach and nothing else is the proper one. 233 00:24:03,440 --> 00:24:09,559 They are like all other communities I have ever met in that regard. However, unless you 234 00:24:09,559 --> 00:24:15,629 can get an approach which covers a variety of ways of dealing with the communication 235 00:24:15,629 --> 00:24:22,629 problem, addresses all those areas and accepts that they are all equally valid, you will 236 00:24:23,349 --> 00:24:29,549 always create more holes, cracks and barriers than you should otherwise have. 237 00:24:29,549 --> 00:24:36,549 Finally, I have a story about the aforementioned UbiDuo. When Esther McVey was the Minister 238 00:24:41,399 --> 00:24:46,909 for Disabled People, she was at a conference and decided to have a chat with the deaf man 239 00:24:46,909 --> 00:24:53,220 who was doing a demonstration. After a long conversation with aides possibly tugging at 240 00:24:53,220 --> 00:25:00,220 her elbow to get her out of the room, we went along and said, "This is wonderful. Isn't 241 00:25:01,349 --> 00:25:06,859 it a great piece of kit?". A woman from the next stall said, "I wonder if she would have 242 00:25:06,859 --> 00:25:13,859 been quite so keen if it wasn't such a tall, good-looking man on the other side". If my 243 00:25:15,070 --> 00:25:19,789 honourable friend had not noticed that, the woman on the next stall certainly had. Allowing 244 00:25:19,789 --> 00:25:26,399 someone to interact on a basic human level is what we are after. This is merely an application 245 00:25:26,399 --> 00:25:31,749 that can be used in the healthcare that we are looking at. Unless we approach it like 246 00:25:31,749 --> 00:25:38,149 that, we will miss far more opportunities to enhance people's lives overall than we 247 00:25:38,149 --> 00:25:39,129 should. 248 00:25:39,129 --> 00:25:46,129 My Lords, I congratulate the noble Lord, Lord Ponsonby, on securing this debate on much 249 00:25:47,970 --> 00:25:54,970 needed improvements for the health needs of deaf people. Although deaf people have the 250 00:25:55,129 --> 00:26:02,129 advantage, unlike the blind, of being able to see, the fact that deafness is not a visible 251 00:26:03,359 --> 00:26:10,359 disability, as the noble Lord, Lord Ponsonby, has said, means that other people are not 252 00:26:10,379 --> 00:26:17,139 necessarily aware that you are deaf. Therefore, less immediate attention is given in trying 253 00:26:17,139 --> 00:26:23,899 to help with any problems that the person will be facing. Perhaps that lack of awareness 254 00:26:23,899 --> 00:26:30,899 of deafness also helps to explain why so few Members of your Lordships' House are taking 255 00:26:33,320 --> 00:26:36,289 part in this important dinner-break debate. 256 00:26:36,289 --> 00:26:43,289 As someone who has had hearing problems since my children were born, and as I have now reached 257 00:26:45,519 --> 00:26:51,669 the limit of what hearing aids can do to help me understand what people are saying, I have 258 00:26:51,669 --> 00:26:58,669 some, although obviously not a complete, understanding of the problems and frustrations that deaf 259 00:27:01,460 --> 00:27:08,460 patients face. Most definitely I have sympathy with the concerns so graphically illustrated 260 00:27:10,330 --> 00:27:17,330 in the pamphlet How the Health Service is Failing Deaf People. It clearly makes sense 261 00:27:18,399 --> 00:27:25,399 for doctors' surgeries or hospitals to have the kind of BSL support or other technical 262 00:27:25,639 --> 00:27:32,419 arrangements to hand that the authors of this pamphlet are advocating should be routine 263 00:27:32,419 --> 00:27:39,419 but clearly are not. Although I suspect that not everyone who is deaf will mind having 264 00:27:41,279 --> 00:27:48,279 someone close to them speak to the doctor, the individual's wishes should be paramount. 265 00:27:52,859 --> 00:27:59,859 Surely, it must be of concern to us all that so many deaf people have a considerably poorer 266 00:28:02,330 --> 00:28:09,330 health record than the average citizen. I was glad to see from a Healthwatch briefing 267 00:28:09,369 --> 00:28:16,340 sent to me over the weekend that a few areas of the country are beginning to realise the 268 00:28:16,340 --> 00:28:23,340 extent of the problems that deaf or hard-of-hearing patients face. In 2013, Kirklees Healthwatch 269 00:28:26,340 --> 00:28:31,539 followed up numerous concerns identified in its survey of the area. I hope that at least 270 00:28:31,539 --> 00:28:37,479 some of these-for example, deaf awareness training being developed and rolled out for 271 00:28:37,479 --> 00:28:43,519 provider staff, including handling phone calls, personal visitors and booking of BSL interpreters-are 272 00:28:43,519 --> 00:28:50,519 beginning to happen. Healthwatch also reports the beginnings of awareness and action in 273 00:28:51,609 --> 00:28:58,609 areas such as York, Wakefield, Staffordshire and Stockport. As well as the important reasons 274 00:28:59,759 --> 00:29:06,759 in the pamphlets for the relevant help proposed, there are other reasons why a greater priority 275 00:29:07,239 --> 00:29:14,239 needs to be given to those who are deaf or in the process of going deaf. Ageing, by itself, 276 00:29:15,080 --> 00:29:21,779 inevitably brings hearing loss. As people are living considerably longer these days, 277 00:29:21,779 --> 00:29:28,609 they will have hearing problems for a longer period of their lives. As well as that, the 278 00:29:28,609 --> 00:29:35,609 way that today's young expose their ears to incredibly loud media sounds will inevitably 279 00:29:35,809 --> 00:29:42,200 mean that when age kicks in, their hearing loss is bound to be considerably worse, last 280 00:29:42,200 --> 00:29:46,859 longer and probably start at an earlier age. 281 00:29:46,859 --> 00:29:51,869 Interestingly, in your Lordships' House, despite all the modern hearing loops that are fitted 282 00:29:51,869 --> 00:29:58,869 in the Committee Rooms, which others may also have found quite difficult to communicate 283 00:29:58,929 --> 00:30:05,929 with, I find that the very best hearing loops available are those that we can switch into 284 00:30:06,899 --> 00:30:13,899 in the Chamber in itself-where we are at the moment. This has a great deal to do with the 285 00:30:14,799 --> 00:30:20,879 considerable improvements that have recently been completed here, but I suspect that it 286 00:30:20,879 --> 00:30:26,609 is also helped by the way that the microphones all hang down from the ceiling and speakers 287 00:30:26,609 --> 00:30:33,609 are located in the seats of every Bench for people to listen through. 288 00:30:33,729 --> 00:30:40,729 As in so many other ways, because so many noble Lords themselves are going through the 289 00:30:43,789 --> 00:30:50,789 stages of ageing, including hearing loss, apart from each one of us checking that appropriate 290 00:30:51,279 --> 00:30:57,279 equipment and help are available in our own doctors' surgeries-which I certainly hope 291 00:30:57,279 --> 00:31:04,279 every one of us here today will do-debates such as this that seek government backing 292 00:31:04,409 --> 00:31:11,409 can also help to raise awareness of the necessary action to be taken. 293 00:31:11,450 --> 00:31:18,450 With that in mind, I look forward to what the Minister can tell us about what the Government 294 00:31:21,099 --> 00:31:28,099 will do to reassure the noble Lord, Lord Ponsonby, about his six questions and the others that 295 00:31:28,989 --> 00:31:35,989 we have added. These considerable changes must take place in doctors' surgeries and 296 00:31:36,409 --> 00:31:43,409 hospitals to meet the wide range of needs described so graphically in the pamphlet, 297 00:31:44,349 --> 00:31:51,349 How the Health Service Is Failing Deaf People. To continue with such failure would surely 298 00:31:54,940 --> 00:31:57,389 be a disgrace. 299 00:31:57,389 --> 00:32:04,389 My Lords, I am very grateful to my noble friend Lord Ponsonby for his initiative and his excellent 300 00:32:05,570 --> 00:32:12,570 speech. I declare my interest as chair of an NHS foundation trust, a consultant and 301 00:32:13,119 --> 00:32:18,239 trainer with Cumberlege Connections and president of GS1. 302 00:32:18,239 --> 00:32:22,789 Parliamentary debates about the quality of public services to deaf people are all too 303 00:32:22,789 --> 00:32:28,330 infrequent. Therefore, like the noble Baroness, Lady Howe, I welcome the opportunity to put 304 00:32:28,330 --> 00:32:34,320 that right tonight. As noble Lords have said, it is particularly opportune because of the 305 00:32:34,320 --> 00:32:40,889 publication on 25 March of this excellent report by the deaf health charity SignHealth. 306 00:32:40,889 --> 00:32:47,700 I was very privileged to speak at the conference held on 25 March to launch the report. 307 00:32:47,700 --> 00:32:53,779 As my noble friend said, the report makes very sobering reading. He went through some 308 00:32:53,779 --> 00:33:00,779 of the details, but the headline results of issues in relation to deaf people in the health 309 00:33:02,169 --> 00:33:07,700 service-underdiagnosis, poorer treatment, poorer communication and lack of accessible 310 00:33:07,700 --> 00:33:14,700 health information-are a salutary wake-up call to us all. As the noble Baroness, Lady 311 00:33:15,599 --> 00:33:22,599 Howe, said, this has been reinforced by some interesting work by local Healthwatches, which 312 00:33:22,929 --> 00:33:29,919 we were sent over the weekend. The noble Baroness referred to Kirklees Healthwatch, but I also 313 00:33:29,919 --> 00:33:36,919 notice work in York, Wakefield, Staffordshire, Enfield, Islington and Stockport. All of those 314 00:33:37,359 --> 00:33:44,259 local Healthwatches are doing good work in their areas. I hope that the Government will 315 00:33:44,259 --> 00:33:51,259 listen to what Healthwatch is saying and act on some of its recommendations and proposals. 316 00:33:52,779 --> 00:33:59,779 My noble friend referred to a number of recommendations made by SignHealth to try to turn the situation 317 00:34:01,129 --> 00:34:07,519 around, such as communications agreements for each deaf person coming into contact with 318 00:34:07,519 --> 00:34:14,179 the health service. It is surely a sensible recommendation that they should be able to 319 00:34:14,179 --> 00:34:21,179 book appointments online using SMS text to communicate with services. Also, health information 320 00:34:21,980 --> 00:34:28,100 needs to be more accessible in other formats, including British Sign Language and subtitles. 321 00:34:28,100 --> 00:34:33,889 Importantly, there is the recommendation on psychological therapies, which ought to be 322 00:34:33,889 --> 00:34:40,480 available to deaf people in British Sign Language nationwide. It has been reported to us that 323 00:34:40,480 --> 00:34:47,480 Ministers have turned that recommendation down. I would be grateful if the Minister 324 00:34:47,520 --> 00:34:54,520 could update the House on that. If Ministers have turned it down, does she think that that 325 00:34:58,790 --> 00:35:05,790 is consistent with the Equality Act duty? I want to ask the Minister about this more 326 00:35:08,150 --> 00:35:15,150 generally. She knows that individual National Health Service bodies and the department's 327 00:35:15,720 --> 00:35:22,720 arm's-length bodies have public sector equality duties under Section 149 of the Equality Act 328 00:35:23,150 --> 00:35:30,150 2010. This duty requires public authorities to have due regard to eliminate discrimination 329 00:35:31,810 --> 00:35:37,490 between those with and without a protected characteristic and to advance equality of 330 00:35:37,490 --> 00:35:43,180 opportunity between those with and without a protected characteristic. My understanding 331 00:35:43,180 --> 00:35:49,080 is that that means removing or minimising disadvantages suffered by people in protected 332 00:35:49,080 --> 00:35:55,070 groups and considering steps to meet the needs of protected groups where they are different 333 00:35:55,070 --> 00:36:01,670 from those of other people. Public authorities are also under a duty to make reasonable adjustments 334 00:36:01,670 --> 00:36:07,630 for disabled people to make sure that a disabled person can use a service as close as reasonably 335 00:36:07,630 --> 00:36:14,630 possible to the standard usually offered to non-disabled people. From the SignHealth work, 336 00:36:16,170 --> 00:36:23,170 it is pretty apparent that for many deaf people that duty is not being effectively applied. 337 00:36:29,230 --> 00:36:36,230 Again, what action are the Government taking to monitor the implementation of the Act's 338 00:36:36,330 --> 00:36:43,330 duty and what action will they take if it is clear that public authorities are failing 339 00:36:43,880 --> 00:36:50,110 in that duty? We have had some debate about the necessity 340 00:36:50,110 --> 00:36:57,110 of interpreting services. I have been contacted by a general practitioner who is particularly 341 00:36:57,910 --> 00:37:04,910 concerned about this issue. She tells me that there is currently confusion in the NHS about 342 00:37:05,830 --> 00:37:12,290 the funding for interpreters since the reorganisation and replacement of primary care trusts by 343 00:37:12,290 --> 00:37:19,140 clinical commissioning groups. My understanding is that in many parts of the country primary 344 00:37:19,140 --> 00:37:26,140 care trusts funded interpreting services but, since they were abolished, there seem to be 345 00:37:27,860 --> 00:37:32,910 two problems. One is that clinical commissioning groups have not always been prepared to continue 346 00:37:32,910 --> 00:37:39,910 to fund those services. Secondly, there has been the issue of how GPs might obtain funding 347 00:37:41,020 --> 00:37:47,070 from NHS England, which is the body that they are now in contract with, for interpreting 348 00:37:47,070 --> 00:37:54,070 services within their own surgeries. I understand that, while at first some GPs were successful, 349 00:37:55,210 --> 00:38:01,140 there are indications that funding is now being withdrawn. That means that GPs will 350 00:38:01,140 --> 00:38:08,140 have to pay for interpreting services out of their practice expenses. Again, I would 351 00:38:09,270 --> 00:38:15,520 be interested in what the Minister has to say about that. 352 00:38:15,520 --> 00:38:20,740 The noble Lord, Lord Borwick, made an interesting speech and I certainly take his point about 353 00:38:20,740 --> 00:38:27,670 literacy and the achievement of the cochlear implant programme. However, I was delighted 354 00:38:27,670 --> 00:38:33,470 with the official recognition of British Sign Language some years ago. I recall the bad 355 00:38:33,470 --> 00:38:39,620 old days when some deaf children were forbidden to use sign language at school. We have all 356 00:38:39,620 --> 00:38:46,620 moved on from that and, for those deaf people who use sign language, it is important that 357 00:38:46,830 --> 00:38:53,280 interpreters are available in the NHS. I also share his concern-he raised the point that 358 00:38:53,280 --> 00:38:59,530 we debated in October-about whether enough people are coming forward to train as teachers 359 00:38:59,530 --> 00:39:02,520 of deaf children. That is a very important point. 360 00:39:02,520 --> 00:39:07,460 I very much take the point raised by the noble Lord, Lord Addington, about online interpretation. 361 00:39:07,460 --> 00:39:14,460 He was really saying that that solution was capable of a much wider interpretation than 362 00:39:16,210 --> 00:39:23,210 simply talking about deaf people themselves. We must surely be on the edge of a revolution 363 00:39:24,650 --> 00:39:31,650 in communications and the use of IT in the health service. This could clearly bring great 364 00:39:34,130 --> 00:39:39,700 advantages for many people who find communications difficult at the moment, but I do not think 365 00:39:39,700 --> 00:39:44,120 it takes away the responsibility of people in the health service to improve the way they 366 00:39:44,120 --> 00:39:51,120 do things now. It is very clear that some deaf people are finding services very inaccessible 367 00:39:51,260 --> 00:39:56,800 indeed. I totally agree with the noble Lord: it is 368 00:39:56,800 --> 00:40:03,800 another way of skinning the cat-that is all. The NHS has a long way to go to use the technology 369 00:40:04,330 --> 00:40:11,090 that the noble Lord has put forward. I welcome the suggestions that he made. 370 00:40:11,090 --> 00:40:17,650 My noble friend Lord Ponsonby asked the Minister a number of questions. I would like to put 371 00:40:17,650 --> 00:40:24,650 forward a number of proposals for the Government to consider. For many years, the outcome of 372 00:40:25,950 --> 00:40:31,620 health services for deaf people has been overlooked. We are talking about a relatively small group 373 00:40:31,620 --> 00:40:38,620 of people-people who inevitably find communication difficult. Will the Government consider the 374 00:40:42,730 --> 00:40:49,730 appointment of a national champion-perhaps a national clinical director-to champion health 375 00:40:50,140 --> 00:40:56,430 services for deaf people? The clinical directors that the department and NHS England have taken 376 00:40:56,430 --> 00:41:02,200 on have been outstanding in giving leadership in relation to a number of clinical areas. 377 00:41:02,200 --> 00:41:08,230 I wonder whether, for deaf people in particular, having a champion at national level could 378 00:41:08,230 --> 00:41:15,090 help disseminate information and really bang heads together to ensure that much more focus 379 00:41:15,090 --> 00:41:22,090 is given to the needs of these people. Secondly, will the Minister encourage Healthwatch 380 00:41:22,170 --> 00:41:28,790 to continue to build on its work to give specific focus on services for deaf people? 381 00:41:28,790 --> 00:41:33,960 Thirdly, will the Minister encourage health and well-being boards at local level to pick 382 00:41:33,960 --> 00:41:40,960 up our concerns about across-the-board services? The noble Lord, Lord Addington, made a very 383 00:41:41,130 --> 00:41:46,350 strong point about the role of the Minister for the Disabled at national level. At local 384 00:41:46,350 --> 00:41:52,450 level, the health and well-being boards could clearly carry out that same function. 385 00:41:52,450 --> 00:41:58,140 Fourthly, will the Minister encourage the development of clinical networks in each local 386 00:41:58,140 --> 00:42:04,080 health area so that there is co-ordination of services across primary, secondary and 387 00:42:04,080 --> 00:42:07,760 tertiary care as regards the needs of deaf people? 388 00:42:07,760 --> 00:42:14,760 Finally, will the Minister institute regular meetings between deaf organisations and the 389 00:42:15,030 --> 00:42:21,050 NHS within each local health area so that there can be proper discussion and debate 390 00:42:21,050 --> 00:42:26,340 about the needs of deaf people? This is a very important debate and I am sure 391 00:42:26,340 --> 00:42:31,200 that we all look forward to a positive response from the Minister. 392 00:42:31,200 --> 00:42:38,200 My Lords, I thank the noble Lord for securing this short debate on the health of deaf people, 393 00:42:41,810 --> 00:42:47,590 and I welcome the opportunity to discuss the serious concerns that he raises. This has 394 00:42:47,590 --> 00:42:54,280 been a really good, well informed debate and many excellent questions have been asked. 395 00:42:54,280 --> 00:42:59,840 I would point out that my scripted speech is six-minutes long, so I hope to answer as 396 00:42:59,840 --> 00:43:05,710 many of the other questions as possible within the rest of the time available to me. However, 397 00:43:05,710 --> 00:43:11,820 in tested and time-honoured tradition, I will send a letter to all noble Lords to address 398 00:43:11,820 --> 00:43:15,650 anything that I have not covered. I would also like to take this opportunity 399 00:43:15,650 --> 00:43:20,780 to pay tribute to the work of SignHealth and the efforts that it has made to achieve equal 400 00:43:20,780 --> 00:43:27,310 access to healthcare and better health outcomes for deaf people. The findings outlined in 401 00:43:27,310 --> 00:43:33,630 its recent report, Sick of It, are truly shocking. The fact that deaf people are more likely 402 00:43:33,630 --> 00:43:38,860 to have undiagnosed conditions such as high blood pressure and diabetes and that they 403 00:43:38,860 --> 00:43:45,850 are more likely to receive inadequate treatment when they are diagnosed, is completely unacceptable. 404 00:43:45,850 --> 00:43:49,840 This Government are committed to delivering health outcomes that are among the best in 405 00:43:49,840 --> 00:43:55,680 the world for people with hearing loss. Before getting to the main issue of the health 406 00:43:55,680 --> 00:44:00,860 of the deaf population, I would like to spend a few seconds outlining service improvements 407 00:44:00,860 --> 00:44:06,500 to those with hearing loss or who are deaf. These include the rollout of a national screening 408 00:44:06,500 --> 00:44:12,650 programme for newborn children; significantly reduced waiting times for assessment and treatment, 409 00:44:12,650 --> 00:44:18,030 with almost all patients now treated within 18 weeks, with the average being four and 410 00:44:18,030 --> 00:44:23,490 a half weeks; and greater choice of hearing aid services-for example, through independent 411 00:44:23,490 --> 00:44:29,170 high street providers. In particular, by taking forward measures which enable the early identification 412 00:44:29,170 --> 00:44:36,170 of deafness, we are able to provide a clear care pathway for services and enable parents 413 00:44:36,520 --> 00:44:40,860 to make informed choices on communication needs. 414 00:44:40,860 --> 00:44:46,850 However, as SignHealth's report shows, it is in the most basic way that we are failing 415 00:44:46,850 --> 00:44:53,540 deaf patients. Small adjustments could make a real difference by enabling those with hearing 416 00:44:53,540 --> 00:45:00,300 loss to communicate with their health providers. Have services thought about how deaf patients 417 00:45:00,300 --> 00:45:06,040 can book a GP appointment if they cannot just pick up a telephone? Once they have made an 418 00:45:06,040 --> 00:45:09,530 appointment, will they know when their name is called or will they be left sitting in 419 00:45:09,530 --> 00:45:15,660 the waiting room? Once they get to see their GP or hospital clinician, will they be able 420 00:45:15,660 --> 00:45:22,660 to communicate with them? I am sure that SignHealth would readily identify with the questions 421 00:45:25,800 --> 00:45:28,780 I have posed. The noble Lord, Lord Addington, talked about 422 00:45:28,780 --> 00:45:34,120 the use of technology in communication, and he brings his personal knowledge to bear. 423 00:45:34,120 --> 00:45:41,120 Online signing is something that might be sensible, and an intelligent use of services 424 00:45:42,250 --> 00:45:48,770 such as Skype might also be helpful. Critical to all of this-and I shall come to it later- 425 00:45:48,770 --> 00:45:55,060 is the co-commissioning of these sorts of services. That sort of approach would not 426 00:45:55,060 --> 00:46:02,060 only give patients their dignity but also help make the GP's job more straightforward. 427 00:46:05,810 --> 00:46:12,810 The noble Baroness, Lady Howe of Idlicote, urged noble Lords to carry out checks in their 428 00:46:12,830 --> 00:46:18,850 own practices. I do not think that anyone would dare not to do so after that. Certainly 429 00:46:18,850 --> 00:46:25,500 with my own practice in Bodmin, in the heart of Cornwall, I can book online to see a doctor 430 00:46:25,500 --> 00:46:31,640 or a nurse. When I turn up for a visit I do not talk to a receptionist, I just press a 431 00:46:31,640 --> 00:46:36,930 touch-screen pad which asks me for my date of birth and my gender. It then says, "Ah! 432 00:46:36,930 --> 00:46:43,770 Are you Mrs Jolly?", and tells me to sit down and wait. All those services would work perfectly 433 00:46:43,770 --> 00:46:49,030 well with deaf people and there is no reason why they should not be replicated throughout 434 00:46:49,030 --> 00:46:56,030 the land. What happens behind the consulting room door may not be as good as all of that-I 435 00:47:00,290 --> 00:47:05,550 just do not know. There are currently over 10 million adults 436 00:47:05,550 --> 00:47:11,360 in England living with hearing loss; the World Health Organisation estimates that by 2030 437 00:47:11,360 --> 00:47:17,760 the figure will rise to 14.5 million. It is therefore vital that health and social care 438 00:47:17,760 --> 00:47:24,150 services are geared up to be able to communicate with deaf people and those with hearing loss 439 00:47:24,150 --> 00:47:30,120 in order to promote good health and address their health needs. All options should be 440 00:47:30,120 --> 00:47:36,970 considered. The noble Lord, Lord Hunt, told the House about the public sector equality 441 00:47:36,970 --> 00:47:42,910 duty. This requires all public bodies, including those who provide health and social care, 442 00:47:42,910 --> 00:47:47,280 to, "advance equality of opportunity" and to, 443 00:47:47,280 --> 00:47:51,370 "have due regard to the need to eliminate discrimination". 444 00:47:51,370 --> 00:47:57,450 SignHealth's Sick of It report is right to remind deaf people that they have a right 445 00:47:57,450 --> 00:48:02,910 to complain when a service provider has not taken their particular needs into account. 446 00:48:02,910 --> 00:48:08,850 However, it is up to the service providers to anticipate the requirements of disabled 447 00:48:08,850 --> 00:48:15,490 people and the reasonable adjustments that may have to be made for them in advance, before 448 00:48:15,490 --> 00:48:21,520 any disabled person attempts to access their service. The reasonable-adjustment duty is 449 00:48:21,520 --> 00:48:28,290 an anticipatory duty, so it is just not acceptable for health services not to be equipped to 450 00:48:28,290 --> 00:48:35,290 provide communication support for those who need it. This may involve the use of British 451 00:48:38,980 --> 00:48:45,120 Sign Language, but it may also involve the use of basic technology such as display screens 452 00:48:45,120 --> 00:48:51,340 in GP waiting rooms. It may also involve something as simple as text messaging-nearly all noble 453 00:48:51,340 --> 00:48:57,950 Lords referred to that-as all of us become increasingly reliant upon this and other electronic 454 00:48:57,950 --> 00:49:02,640 forms of communication. My noble friend Lord Borwick talked about 455 00:49:02,640 --> 00:49:09,640 skills possibly being superseded by technology and referred to cochlear implants, texts and 456 00:49:11,470 --> 00:49:18,200 the internet. I defy any noble Lord not to be touched by the moving story of Joanne Milne 457 00:49:18,200 --> 00:49:24,560 as she heard for the first time this week but a lot of this will take a long time to 458 00:49:24,560 --> 00:49:31,560 roll out. It will take a while before the youngsters reach the age of older people who 459 00:49:34,460 --> 00:49:41,030 are deaf or have hearing loss. This will not be an instant fix. 460 00:49:41,030 --> 00:49:48,030 I am happy to be able to report that progress is being made on the NHS information standard. 461 00:49:48,540 --> 00:49:54,820 As part of the commitment to improve the experience of patients using NHS services and empower 462 00:49:54,820 --> 00:50:01,820 people to be equal partners in their own care, NHS England is developing an information standard 463 00:50:01,860 --> 00:50:07,630 for the provision of accessible, personalised information. The standard will ensure that 464 00:50:07,630 --> 00:50:14,630 disabled patients, service users and carers receive information from NHS bodies and providers 465 00:50:14,670 --> 00:50:21,670 of NHS care in formats that they can understand. It also requires that they receive appropriate 466 00:50:21,720 --> 00:50:28,720 support to enable them to communicate with service providers. Successful implementation 467 00:50:29,210 --> 00:50:34,870 of this information standard will improve the health outcomes and experience of disabled 468 00:50:34,870 --> 00:50:40,700 people. It will also reduce the number of appointments and screening opportunities missed 469 00:50:40,700 --> 00:50:47,440 by patients who have received invitations or information in formats that are inappropriate 470 00:50:47,440 --> 00:50:54,440 for them. It is intended that the standard will be finalised in late 2014, with organisations 471 00:50:55,130 --> 00:51:02,130 required to comply in 2015. Alongside the statutory information standard, NHS England 472 00:51:03,740 --> 00:51:09,230 will publish guidance on making reasonable adjustments to meet the communication needs 473 00:51:09,230 --> 00:51:16,230 of service users with disabilities. We know that there is a need to improve both 474 00:51:16,530 --> 00:51:20,890 the commissioning and integration of health and social care services for people with hearing 475 00:51:20,890 --> 00:51:27,770 loss, as well as the provision of new and innovative models of care. This is why we 476 00:51:27,770 --> 00:51:34,150 are also developing a new action plan on hearing loss. The action plan will identify the key 477 00:51:34,150 --> 00:51:40,020 actions that will make a real difference to health and social care outcomes for children, 478 00:51:40,020 --> 00:51:45,820 young people and adults with hearing loss. NHS England is currently engaging with a range 479 00:51:45,820 --> 00:51:51,550 of stakeholders, including the Department of Health, Public Health England, other government 480 00:51:51,550 --> 00:51:57,400 departments and agencies and key stakeholders, and aims to publish the action plan as soon 481 00:51:57,400 --> 00:51:58,110 as possible. 482 00:51:58,110 --> 00:52:05,110 I hope that I have been able to reassure the House that the Government have a strong commitment 483 00:52:05,260 --> 00:52:12,000 to promoting the needs of deaf people across a range of public services but, in particular, 484 00:52:12,000 --> 00:52:17,400 ensuring that deaf people have equal access to health and social care and improved outcomes 485 00:52:17,400 --> 00:52:24,400 equal to people who do not have hearing loss. Equality is the watchword. 486 00:52:26,840 --> 00:52:33,180 To answer noble Lords' questions, the noble Lord, Lord Hunt, asked about the decision 487 00:52:33,180 --> 00:52:38,490 on psychological therapy provided in British Sign Language and where the responsibility 488 00:52:38,490 --> 00:52:45,490 for that should be in specialised commissioning. Following advice from the prescribed specialised 489 00:52:46,020 --> 00:52:52,230 services advisory group, and in consultation with NHS England, Ministers have taken the 490 00:52:52,230 --> 00:52:58,100 decision that responsibility for commissioning psychological therapies for deaf sign language 491 00:52:58,100 --> 00:53:02,510 users should remain with the clinical commissioning groups. 492 00:53:02,510 --> 00:53:09,510 The noble Lord, Lord Hunt, also made five points. There was that of the national champion 493 00:53:12,740 --> 00:53:19,620 and how to build on the work thus far. I am happy to take that back and will write to 494 00:53:19,620 --> 00:53:25,170 him. On health and well-being boards, they should pick up across-the-board services. 495 00:53:25,170 --> 00:53:29,220 We hope that they are doing so. I suspect that health and well-being boards will, in 496 00:53:29,220 --> 00:53:36,220 their second report for this coming year, pick up on that sort of thing if they are 497 00:53:37,260 --> 00:53:43,920 not doing so already. On co-ordination of services, again, it should be within the gift 498 00:53:43,920 --> 00:53:48,330 of health and well-being boards to ensure that social care and all health services are 499 00:53:48,330 --> 00:53:55,330 not only properly commissioned but also properly co-ordinated. It sounds an admirable idea 500 00:53:56,140 --> 00:54:00,270 that there should be regular meetings with the NHS in each local area for people with 501 00:54:00,270 --> 00:54:07,270 hearing loss and deafness. I imagine many people with other sorts of disability would 502 00:54:07,770 --> 00:54:11,440 like to see that as well. Perhaps that is something that Healthwatch might be able to 503 00:54:11,440 --> 00:54:16,120 facilitate. 504 00:54:16,120 --> 00:54:21,860 Do GPs have to pay for their translation services? Each provider of a public service is responsible 505 00:54:21,860 --> 00:54:27,780 for ensuring that they make reasonable adjustments to meet the needs of disabled people. This 506 00:54:27,780 --> 00:54:32,990 is not funded centrally but must be found from within local budgets. 507 00:54:32,990 --> 00:54:39,770 The noble Lord, Lord Addington, asked about co-ordinating help for deaf people in other 508 00:54:39,770 --> 00:54:45,110 fields, such as education and employment. The Minister of State for Disabled People, 509 00:54:45,110 --> 00:54:52,110 in his capacity as chair of the interdepartmental group on disability, recently wrote to Ministers 510 00:54:52,800 --> 00:54:58,470 in other government departments to ask what their departments are doing to support their 511 00:54:58,470 --> 00:55:05,470 deaf users. On the questions of the noble Lord, Lord Ponsonby, 512 00:55:06,220 --> 00:55:13,220 about plans to ensure that NHS Choices increases the number of videos available in BSL, NHS 513 00:55:14,520 --> 00:55:21,490 Choices is very keen to provide more BSL content. It has approached SignHealth and in turn secured 514 00:55:21,490 --> 00:55:26,290 funding for the existing BSL videos. Noble Lords might be interested to know that there 515 00:55:26,290 --> 00:55:31,950 are videos available on: breast cancer, diabetes, heart disease, lung cancer, prostate cancer, 516 00:55:31,950 --> 00:55:38,680 back pain, depression and low mood, getting tested for Chlamydia, preventing high cholesterol 517 00:55:38,680 --> 00:55:42,950 and tinnitus. Those are the ones currently signed. 518 00:55:42,950 --> 00:55:49,950 What would the Minister recommend to a deaf person who wants to see a doctor but is told 519 00:55:50,930 --> 00:55:56,090 that no interpreter is available? We recommend that they lodge a formal complaint with the 520 00:55:56,090 --> 00:56:01,760 GP practice. If the complaint is not resolved, we recommend that the complaint is escalated 521 00:56:01,760 --> 00:56:08,760 to CCG or NHS England as set out in the complaints procedure. 522 00:56:10,869 --> 00:56:14,630 What does the Minister think would be the best way to raise deaf awareness among staff 523 00:56:14,630 --> 00:56:19,950 working in the health service? It is ultimately the responsibility of individual employers 524 00:56:19,950 --> 00:56:25,410 to support the development of the staff they employ. However, Health Education England 525 00:56:25,410 --> 00:56:30,060 will provide leadership and work with local education training boards-LETBs-regulatory 526 00:56:30,060 --> 00:56:36,760 bodies and health care providers to ensure professional and personal development continues 527 00:56:36,760 --> 00:56:40,650 beyond the end of formal training. 528 00:56:40,650 --> 00:56:46,119 What steps will the Government take to encourage NHS England and Public Health England to promote 529 00:56:46,119 --> 00:56:52,600 the health of deaf people? The NHS is a universal service for the people of England and NHS 530 00:56:52,600 --> 00:56:58,780 England is under specific legal duties in relation to tackling health inequalities and 531 00:56:58,780 --> 00:57:05,050 advancing equality. The Government will hold NHS England to account for how well it discharges 532 00:57:05,050 --> 00:57:07,840 these duties. 533 00:57:07,840 --> 00:57:13,340 Can we expect NHS computer systems to be able to tell us how many deaf people there are 534 00:57:13,340 --> 00:57:19,810 and which services they are accessing? The short answer is regrettably no, not yet. However, 535 00:57:19,810 --> 00:57:26,369 the new system being commissioned by NHS England to upgrade the hospital episodes statistics-the 536 00:57:26,369 --> 00:57:33,369 HES service-will mean that they include a richer source of hospital data, plus data 537 00:57:33,610 --> 00:57:39,210 from care provided outside hospital. While this will not tell us how many deaf people 538 00:57:39,210 --> 00:57:46,210 there are, it will tell us about deaf people's access of services. I am sure other improvements 539 00:57:46,570 --> 00:57:53,369 to care data in time will be able to give us the number of deaf people there are. 540 00:57:53,369 --> 00:57:57,850 Will implementation of the proposed information standard be supported by a funded programme 541 00:57:57,850 --> 00:58:03,640 which can help to educate and support? As part of the engagement activity, we asked 542 00:58:03,640 --> 00:58:10,369 health and care professionals and organisations to advise us as to the challenges they experience 543 00:58:10,369 --> 00:58:15,550 in meeting the communication needs of patients, carers and services users, as well as the 544 00:58:15,550 --> 00:58:22,550 ways they have identified to overcome the challenges. These will be reviewed. The intention 545 00:58:22,980 --> 00:58:28,220 is that the findings will inform the drafting of the standard itself and the development 546 00:58:28,220 --> 00:58:33,869 of supporting tools. Regarding the psychological therapies question, following a device from 547 00:58:33,869 --> 00:58:40,869 the prescribed specialised services group, Ministers have decided that these services 548 00:58:45,770 --> 00:58:48,110 should be commissioned by CCGs. 549 00:58:48,110 --> 00:58:55,100 I move on to the question of the noble Lord, Lord Borwick: what can be done to encourage 550 00:58:55,100 --> 00:58:59,520 more teachers to work in this specialist area? Schools and local authorities are responsible 551 00:58:59,520 --> 00:59:05,790 for assessing their workforce and have adequate recruitment and training strategies in place. 552 00:59:05,790 --> 00:59:11,980 We expect authorities to work with schools so that they know and build the appropriate 553 00:59:11,980 --> 00:59:17,690 skills for the teaching workforce, and the DfE is funding scholarships for teachers to 554 00:59:17,690 --> 00:59:24,690 develop their knowledge and skills, including postgraduate qualifications. Regarding the 555 00:59:25,690 --> 00:59:32,690 question of texting information, this sort of thing is a local decision. I have told 556 00:59:33,930 --> 00:59:40,930 noble Lords how my local GP practice chose to sort it, and others may choose to use texts. 557 00:59:41,270 --> 00:59:48,270 On teacher numbers, so far 600 teachers have achieved or are working towards a qualification 558 00:59:49,110 --> 00:59:54,750 relating to special education needs, and a further 500 have applied for the current funding 559 00:59:54,750 --> 01:00:01,750 round. I have exhausted the supply of responses from the Dispatch Box, but I feel absolutely 560 01:00:05,070 --> 01:00:12,070 sure that when we go through Hansard, many more questions that will come to light, so 561 01:00:12,840 --> 01:00:19,840 we will write a letter to all noble Lords who have taken part in the debate.