WEBVTT 00:00:03.070 --> 00:00:06.899 Lord Ponsonby of Shulbrede 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 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 00:00:31.660 --> 00:00:38.660 or become profoundly deaf before the age of five. They usually prefer to communicate in 00:00:39.420 --> 00:00:46.420 British Sign Language and see themselves as part of the deaf community. By this definition, 00:00:47.149 --> 00:00:52.640 there are an estimated 70,000 deaf people in the United Kingdom. 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, 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 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 00:01:16.170 --> 00:01:21.700 SignHealth in partnership with the University of Bristol. I am particularly indebted to 00:01:21.700 --> 00:01:26.650 Dr Andrew Alexander, SignHealth's medical director, who provided me with the briefing 00:01:26.650 --> 00:01:29.360 for this debate. 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 00:01:34.470 --> 00:01:37.090 in this country. Although there have been a few small studies 00:01:37.090 --> 00:01:44.090 looking at access to health-all found it poor-no Government have ever specifically addressed 00:01:45.610 --> 00:01:51.560 the health of deaf people as I have defined them here. The closest initiative was Mental 00:01:51.560 --> 00:01:57.590 Health and Deafness-Towards Equity and Access. Although this started as a consultation on 00:01:57.590 --> 00:02:03.399 mental health, it included a lot on the wider barriers faced by deaf people. The report 00:02:03.399 --> 00:02:09.470 was supported by funding which was received by each primary care trust to help it implement 00:02:09.470 --> 00:02:13.580 the recommendations of the report. 00:02:13.580 --> 00:02:20.580 Deaf health rarely features on any agenda, with the notable exception of that of the 00:02:20.690 --> 00:02:25.050 House of Lords. Even within health and equality programmes, attention is normally focused 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 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 00:02:37.430 --> 00:02:43.420 the case on the health front line as well. Most staff will think that speaking louder 00:02:43.420 --> 00:02:49.890 or writing things down will solve the problem. When surveyed, a very high percentage of doctors 00:02:49.890 --> 00:02:54.390 wrongly thought that they had communicated well with their deaf patients. 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, 00:03:01.610 --> 00:03:08.610 an online survey was conducted by Ipsos MORI; secondly, personal health assessments were 00:03:09.100 --> 00:03:15.620 made of 298 deaf people, including looking at their blood pressure and BMI and taking 00:03:15.620 --> 00:03:22.500 blood tests, et cetera; thirdly, there were in-depth interviews of deaf people. The findings 00:03:22.500 --> 00:03:28.740 were as follows. First, underdiagnosis and undertreatment of potentially serious conditions 00:03:28.740 --> 00:03:35.660 was more common for deaf people. Secondly, high blood pressure was almost twice as common 00:03:35.660 --> 00:03:41.850 in deaf people as in the rest of the population. Thirdly, deaf people have generally healthier 00:03:41.850 --> 00:03:46.540 lifestyles than the rest of the population in terms of smoking and alcohol but are more 00:03:46.540 --> 00:03:53.480 likely to be overweight. Fourthly, there is underdiagnosis: deaf people are twice as likely 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 00:03:58.760 --> 00:04:05.760 more likely to have undiagnosed diabetes, high cholesterol and cardiovascular disease. 00:04:06.680 --> 00:04:12.230 Moving on to poorer treatment, the report also found that when deaf people have been 00:04:12.230 --> 00:04:18.940 diagnosed, they are more likely to be on inadequate treatment for those conditions. It has been 00:04:18.940 --> 00:04:25.310 estimated that if the deaf community had the same health profile as the general population, 00:04:25.310 --> 00:04:28.900 the NHS would save about £30 million per year. 00:04:28.900 --> 00:04:35.900 I will now talk about access and communication. A large number of deaf people reported not 00:04:36.480 --> 00:04:43.090 seeing their GP because they were put off by the prospect of poor communication. A large 00:04:43.090 --> 00:04:49.340 proportion booked appointments by going to the practice in person-some 45%-whereas very 00:04:49.340 --> 00:04:55.900 few hearing people book appointments in this way. Only 15% of deaf people said that their 00:04:55.900 --> 00:05:02.270 GP was good at listening to them, compared to 51% of the general population. At most, 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 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 00:05:15.610 --> 00:05:22.610 only 5% would prefer to communicate in that way. This disparity between how deaf people 00:05:23.430 --> 00:05:28.680 have to communicate and how they would like to communicate is an indictment of the health 00:05:28.680 --> 00:05:35.680 service, and an explanation for the poorer health outcomes of deaf people. Only 25% of 00:05:36.330 --> 00:05:42.890 deaf people have confidence in their doctor, compared to 67% of the general population. 00:05:42.890 --> 00:05:49.570 There is also a wider issue about access to information. Because health information is 00:05:49.570 --> 00:05:56.250 not widely available in an accessible format, a lot of the deaf people studied were unsure 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 00:06:02.970 --> 00:06:08.060 many hearing patients would find out more information from friends, family or the internet, 00:06:08.060 --> 00:06:13.950 these options were less available to deaf patients. As a result, few of the deaf people 00:06:13.950 --> 00:06:20.800 interviewed through the in-depth process appeared actively engaged with their own personal health 00:06:20.800 --> 00:06:24.530 management. 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 00:06:30.490 --> 00:06:36.430 of the deaf community is about equal rather than special treatment. 00:06:36.430 --> 00:06:41.430 The first prescription is that systems within the health service need to be accessible. 00:06:41.430 --> 00:06:45.870 From booking an appointment to getting test results, there should be a communication agreement 00:06:45.870 --> 00:06:52.710 for each deaf patient, which is then coded and recorded in their patient record. Secondly, 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 00:06:58.240 --> 00:07:03.300 with services. Thirdly, deaf patients should be able to communicate during consultations 00:07:03.300 --> 00:07:10.300 in their preferred language. Health services must expect and plan for deaf patients. Clinicians 00:07:14.810 --> 00:07:20.530 should remember that interpreters are not just for deaf people but help the doctor to 00:07:20.530 --> 00:07:26.930 understand and diagnose properly. Fourthly, providers must make sure that staff know how 00:07:26.930 --> 00:07:32.840 to book an interpreter and ensure that interpreters are suitably qualified. Fifthly, health information 00:07:32.840 --> 00:07:38.680 needs to be made accessible in other formats, including BSL and subtitles. Currently, only 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 00:07:46.840 --> 00:07:51.830 standard on accessibility should be supported with a funded programme. 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 00:07:58.240 --> 00:08:03.560 there any plans to ensure that NHS Choices increases the number of videos available in 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 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 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 00:08:26.110 --> 00:08:33.110 problems in booking interpreters. Thirdly, what steps will the Government take to encourage 00:08:33.630 --> 00:08:40.549 the NHS Executive and Public Health England to promote the health of deaf people? Fourthly, 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 00:08:46.060 --> 00:08:53.060 there are and which services they are accessing? Fifthly, will implementation of the proposed 00:08:53.150 --> 00:08:59.390 information standard be supported with a funded programme which can help to educate and support 00:08:59.390 --> 00:09:02.150 health services? 00:09:02.150 --> 00:09:09.150 My sixth question is one that I sent the Minister earlier regarding whether psychological therapies 00:09:15.820 --> 00:09:21.560 providing BSL should be the responsibility of specialised commissioners. I understand 00:09:21.560 --> 00:09:26.940 that the Minister has since decided that psychological therapies for deaf people should not be on 00:09:26.940 --> 00:09:33.279 the list of prescribed services. Therefore, in the updated situation, my question is: 00:09:33.279 --> 00:09:39.290 how can we ensure that psychological services nationwide are available for deaf people? 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 00:09:49.960 --> 00:09:56.040 think would be the best way to raise deaf awareness among staff working in the health 00:09:56.040 --> 00:09:56.410 service? 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 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 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 00:10:19.270 --> 00:10:23.260 the questions that I have raised. 00:10:23.260 --> 00:10:28.380 My Lords, I am grateful to the noble Lord, Lord Ponsonby, for bringing this matter to 00:10:28.380 --> 00:10:32.690 debate following the SignHealth report. 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 00:10:38.700 --> 00:10:44.940 the Ewing Foundation for deaf children, a charity that has, for the past 60 years, helped 00:10:44.940 --> 00:10:49.510 to improve the teaching of children who use their residual hearing and lip reading to 00:10:49.510 --> 00:10:52.620 communicate by speech. 00:10:52.620 --> 00:10:58.589 The change in the prospects and outcomes for deaf children due to the introduction of cochlear 00:10:58.589 --> 00:11:03.270 implants, digital hearing aids and newborn hearing screening is one of the most exciting 00:11:03.270 --> 00:11:08.870 stories in disability. Noble Lords may have seen the publicity in the papers on Friday, 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 00:11:14.740 --> 00:11:20.690 when her cochlear implants were turned on. For the first time, she can hear music, the 00:11:20.690 --> 00:11:26.220 laughter of babies and the songs of birds. This revolution has come from cochlear implants, 00:11:26.220 --> 00:11:31.899 which will radically reduce the disabling effects of profound deafness in children and 00:11:31.899 --> 00:11:32.810 adults. 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 00:11:38.620 --> 00:11:45.050 background. A statistic on the page about communication issues claims that 80% of deaf 00:11:45.050 --> 00:11:49.660 people want to communicate using British Sign Language. The noble Lord suggested that that 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. 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 00:12:01.620 --> 00:12:07.920 more ordinary definition of the word, are elderly people who do not use British Sign 00:12:07.920 --> 00:12:14.920 Language. Indeed, the CRIDE report said that 79% of deaf children use only spoken English. 00:12:16.040 --> 00:12:20.399 It may be that the definition of deaf depends on who is hearing it. 00:12:20.399 --> 00:12:27.399 A strong part of good communication is literacy. Unfortunately, communicating through sign 00:12:27.970 --> 00:12:33.770 language while learning to read and write in English is like talking in English and 00:12:33.770 --> 00:12:40.770 reading and writing in Chinese. I am filled with admiration for all the children who can 00:12:41.060 --> 00:12:47.220 do it. Noble Lords may have strong opinions about whether tweeting and texting can really 00:12:47.220 --> 00:12:53.959 be described as literature but they are fundamental to the lives of many teenagers nowadays. There 00:12:53.959 --> 00:12:59.350 is some great technology coming forward. The Apple digital assistant, Siri, and many other 00:12:59.350 --> 00:13:06.070 programs can transcribe your questions, and a doctor's replies can be sent from an iPad 00:13:06.070 --> 00:13:13.070 to a simultaneous remote caption service. All these new technologies need literacy. 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 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 00:13:26.240 --> 00:13:28.580 better. 00:13:28.580 --> 00:13:34.970 Another feature of the report is isolation, and deafness is very isolating. Research has 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 00:13:44.350 --> 00:13:49.580 loss seems to speed up dementia, so perhaps hearing loss in older patients should be treated 00:13:49.580 --> 00:13:54.580 more aggressively when it is first diagnosed, and deaf awareness training given to more 00:13:54.580 --> 00:13:59.440 health professionals. 00:13:59.440 --> 00:14:04.120 Time after time, surveys suggest that there is a correlation between good health and good 00:14:04.120 --> 00:14:09.500 education, so the most powerful advantage to the health of deaf people is to make sure 00:14:09.500 --> 00:14:16.500 that they get a great education. Profoundly deaf children now, thanks to cochlear implants, 00:14:17.720 --> 00:14:23.330 can be educated primarily in mainstream schools, with hearing friends and ordinary prospects 00:14:23.330 --> 00:14:25.519 for the future. 00:14:25.519 --> 00:14:31.970 But cochlear implants are expensive, although not so much in their implantation, which, 00:14:31.970 --> 00:14:38.019 like everything electronic, is improving technically and reducing in price. The real cost comes 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, 00:14:44.860 --> 00:14:50.430 this is so much cheaper than a lifetime of interpreters. I must compliment all parties 00:14:50.430 --> 00:14:55.839 for getting on with the cochlear implant programme and not stinting on this project. Ten thousand 00:14:55.839 --> 00:15:00.310 people have had cochlear implants so far. That is a marvellous achievement and it is 00:15:00.310 --> 00:15:05.330 changing society. There are now only a very small number of children below the age of 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 00:15:11.779 --> 00:15:17.610 and fewer deaf people. Who knows what will happen? Many other skills have been superseded 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 00:15:22.709 --> 00:15:29.709 language but they will gradually become a tiny minority of deaf people. 00:15:30.250 --> 00:15:36.899 Some 40% of deaf children have disabilities in addition to hearing loss. Deafness and 00:15:36.899 --> 00:15:43.899 autism or deaf and blind with a learning disability are combinations that are becoming more common, 00:15:44.010 --> 00:15:51.010 partly as a function of doctors saving extremely premature babies who in past years would have 00:15:51.130 --> 00:15:58.130 died. These babies can now survive at 22 weeks' gestation, but with multiple problems. Some 00:15:58.230 --> 00:16:03.700 parents are better than others at caring for a child with challenging behaviour who may 00:16:03.700 --> 00:16:10.700 never live independently but, sadly, some children are effectively abandoned by their 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 00:16:18.279 --> 00:16:21.269 short pregnancy. 00:16:21.269 --> 00:16:27.640 I have two questions for the Minister. The first concerns the reducing number, and increasing 00:16:27.640 --> 00:16:33.320 age profile of, qualified teachers of the deaf. The report stresses the importance of 00:16:33.320 --> 00:16:37.720 good health education for deaf people. Deaf children and young people need to be equipped 00:16:37.720 --> 00:16:43.870 with information and strategies to access health services independently as adults. To 00:16:43.870 --> 00:16:50.589 achieve that, we will need more teachers of the deaf. How can we get them? 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 00:16:54.910 --> 00:16:58.839 friend Lady Brinton, and she replied with information about the national scholarship 00:16:58.839 --> 00:17:05.079 fund. How many teachers have applied for, and how many have been granted, help from 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 00:17:11.749 --> 00:17:17.339 enough to solve the problem, so what else can be done to encourage more teachers to 00:17:17.339 --> 00:17:20.220 work in this specialist area? 00:17:20.220 --> 00:17:26.769 Secondly, can we increase the amount of communication in our health service that is duplicated both 00:17:26.769 --> 00:17:33.600 verbally and by text? It is far cheaper to have a text system of booking appointments 00:17:33.600 --> 00:17:39.109 than an interpreter, and that expenditure will benefit not only deaf patients but all 00:17:39.109 --> 00:17:43.749 patients who can read and write in English. 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 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 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 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 00:18:15.429 --> 00:18:19.549 other and if something gets in the way of being able to communicate properly, we will 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 00:18:27.090 --> 00:18:30.119 right. 00:18:30.119 --> 00:18:37.119 I have to declare an interest. I am chairman of a company called Microlink, which supports 00:18:37.720 --> 00:18:43.119 disabled people through its innovations, usually involving computing. This has led me to take 00:18:43.119 --> 00:18:48.179 a closer look at this area. Indeed, one of our case studies concerned being an online 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 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 00:18:59.679 --> 00:19:02.369 a person around. 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 00:19:08.059 --> 00:19:15.059 as much independence as possible. A translator is an expensive, difficult piece of kit you 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 00:19:22.049 --> 00:19:29.049 health or reproduction, particularly if they are there all the time. Having something online, 00:19:29.989 --> 00:19:36.989 as described here, seems a perfectly sensible way forward but to use it both parties must 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 00:19:45.090 --> 00:19:51.600 throughout the system for the client base and the provider is essential to getting the 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 00:20:00.720 --> 00:20:07.330 be done comparatively easily, which seems to be the case, everyone must know. That would 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 00:20:13.590 --> 00:20:15.139 the night speaking about that. 00:20:15.139 --> 00:20:22.139 As the noble Lord, Lord Borwick, has mentioned, lots of technologies are language-based. If 00:20:22.950 --> 00:20:29.950 you are literate, you would have another means of communication. As someone who is dyslexic, 00:20:32.019 --> 00:20:39.019 I have a little story about one of these bits of technology. Through the aforementioned 00:20:43.720 --> 00:20:50.720 interest, I saw a wonderful piece of kit which addresses literacy and gives a person some 00:20:51.759 --> 00:20:54.899 personal space. The UbiDuo comes from the States, although I do not think that we would 00:20:54.899 --> 00:20:57.970 have given it that name. Basically, you use two keyboards and two screens that are roughly 00:20:57.970 --> 00:21:04.970 the size of small computers, and you get instant translation of your communication to someone 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 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 00:21:16.309 --> 00:21:23.019 it because I am dyslexic, which shows that everything has its limitations. However, if 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 00:21:29.909 --> 00:21:35.059 other person. A line of communication can be established. There are many different types 00:21:35.059 --> 00:21:40.220 and uses of language. If we can establish the fact that they are available and known 00:21:40.220 --> 00:21:46.029 about, these problems will be cut. 00:21:46.029 --> 00:21:53.029 Most of what we are talking about will cut across government departments. How would anything 00:21:54.379 --> 00:22:00.649 being talked about here not be covered in one's health employment profile? I bumped 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 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 00:22:10.720 --> 00:22:17.720 Minister of State. There will be the same problems in health, employment and education. 00:22:21.759 --> 00:22:28.759 Everything relates and cross-references. How we deal with that is very important. 00:22:29.899 --> 00:22:36.899 When someone leaves a medical establishment, hospital or doctor's surgery, how will they 00:22:43.450 --> 00:22:50.450 interpret the lifestyle and support that they will receive? I know Mike Penning reasonably 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 00:22:56.799 --> 00:23:02.440 other departments can make sure that this support is followed through. If deaf people 00:23:02.440 --> 00:23:08.489 are overweight and want healthier lifestyles, it is true that they have more trouble accessing, 00:23:08.489 --> 00:23:15.369 for example, exercise and outdoor activity. What are we doing to make sure that they can 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 00:23:22.840 --> 00:23:25.799 one place to another. 00:23:25.799 --> 00:23:32.799 We have just heard a very positive description of what might happen with cochlea implants. 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. 00:23:37.879 --> 00:23:44.879 However, as the noble Lord said, most people's hearing problems are probably late onset. 00:23:46.749 --> 00:23:53.749 As with most disabilities, they build up. The deaf community has vociferous factions 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 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. 00:24:03.440 --> 00:24:09.559 They are like all other communities I have ever met in that regard. However, unless you 00:24:09.559 --> 00:24:15.629 can get an approach which covers a variety of ways of dealing with the communication 00:24:15.629 --> 00:24:22.629 problem, addresses all those areas and accepts that they are all equally valid, you will 00:24:23.349 --> 00:24:29.549 always create more holes, cracks and barriers than you should otherwise have. 00:24:29.549 --> 00:24:36.549 Finally, I have a story about the aforementioned UbiDuo. When Esther McVey was the Minister 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 00:24:46.909 --> 00:24:53.220 who was doing a demonstration. After a long conversation with aides possibly tugging at 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 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 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 00:25:15.070 --> 00:25:19.789 honourable friend had not noticed that, the woman on the next stall certainly had. Allowing 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 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 00:25:31.749 --> 00:25:38.149 that, we will miss far more opportunities to enhance people's lives overall than we 00:25:38.149 --> 00:25:39.129 should. 00:25:39.129 --> 00:25:46.129 My Lords, I congratulate the noble Lord, Lord Ponsonby, on securing this debate on much 00:25:47.970 --> 00:25:54.970 needed improvements for the health needs of deaf people. Although deaf people have the 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 00:26:03.359 --> 00:26:10.359 disability, as the noble Lord, Lord Ponsonby, has said, means that other people are not 00:26:10.379 --> 00:26:17.139 necessarily aware that you are deaf. Therefore, less immediate attention is given in trying 00:26:17.139 --> 00:26:23.899 to help with any problems that the person will be facing. Perhaps that lack of awareness 00:26:23.899 --> 00:26:30.899 of deafness also helps to explain why so few Members of your Lordships' House are taking 00:26:33.320 --> 00:26:36.289 part in this important dinner-break debate. 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 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 00:26:51.669 --> 00:26:58.669 some, although obviously not a complete, understanding of the problems and frustrations that deaf 00:27:01.460 --> 00:27:08.460 patients face. Most definitely I have sympathy with the concerns so graphically illustrated 00:27:10.330 --> 00:27:17.330 in the pamphlet How the Health Service is Failing Deaf People. It clearly makes sense 00:27:18.399 --> 00:27:25.399 for doctors' surgeries or hospitals to have the kind of BSL support or other technical 00:27:25.639 --> 00:27:32.419 arrangements to hand that the authors of this pamphlet are advocating should be routine 00:27:32.419 --> 00:27:39.419 but clearly are not. Although I suspect that not everyone who is deaf will mind having 00:27:41.279 --> 00:27:48.279 someone close to them speak to the doctor, the individual's wishes should be paramount. 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 00:28:02.330 --> 00:28:09.330 health record than the average citizen. I was glad to see from a Healthwatch briefing 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 00:28:16.340 --> 00:28:23.340 extent of the problems that deaf or hard-of-hearing patients face. In 2013, Kirklees Healthwatch 00:28:26.340 --> 00:28:31.539 followed up numerous concerns identified in its survey of the area. I hope that at least 00:28:31.539 --> 00:28:37.479 some of these-for example, deaf awareness training being developed and rolled out for 00:28:37.479 --> 00:28:43.519 provider staff, including handling phone calls, personal visitors and booking of BSL interpreters-are 00:28:43.519 --> 00:28:50.519 beginning to happen. Healthwatch also reports the beginnings of awareness and action in 00:28:51.609 --> 00:28:58.609 areas such as York, Wakefield, Staffordshire and Stockport. As well as the important reasons 00:28:59.759 --> 00:29:06.759 in the pamphlets for the relevant help proposed, there are other reasons why a greater priority 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, 00:29:15.080 --> 00:29:21.779 inevitably brings hearing loss. As people are living considerably longer these days, 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 00:29:28.609 --> 00:29:35.609 way that today's young expose their ears to incredibly loud media sounds will inevitably 00:29:35.809 --> 00:29:42.200 mean that when age kicks in, their hearing loss is bound to be considerably worse, last 00:29:42.200 --> 00:29:46.859 longer and probably start at an earlier age. 00:29:46.859 --> 00:29:51.869 Interestingly, in your Lordships' House, despite all the modern hearing loops that are fitted 00:29:51.869 --> 00:29:58.869 in the Committee Rooms, which others may also have found quite difficult to communicate 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 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 00:30:14.799 --> 00:30:20.879 considerable improvements that have recently been completed here, but I suspect that it 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 00:30:26.609 --> 00:30:33.609 are located in the seats of every Bench for people to listen through. 00:30:33.729 --> 00:30:40.729 As in so many other ways, because so many noble Lords themselves are going through the 00:30:43.789 --> 00:30:50.789 stages of ageing, including hearing loss, apart from each one of us checking that appropriate 00:30:51.279 --> 00:30:57.279 equipment and help are available in our own doctors' surgeries-which I certainly hope 00:30:57.279 --> 00:31:04.279 every one of us here today will do-debates such as this that seek government backing 00:31:04.409 --> 00:31:11.409 can also help to raise awareness of the necessary action to be taken. 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 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 00:31:28.989 --> 00:31:35.989 we have added. These considerable changes must take place in doctors' surgeries and 00:31:36.409 --> 00:31:43.409 hospitals to meet the wide range of needs described so graphically in the pamphlet, 00:31:44.349 --> 00:31:51.349 How the Health Service Is Failing Deaf People. To continue with such failure would surely 00:31:54.940 --> 00:31:57.389 be a disgrace. 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 00:32:05.570 --> 00:32:12.570 speech. I declare my interest as chair of an NHS foundation trust, a consultant and 00:32:13.119 --> 00:32:18.239 trainer with Cumberlege Connections and president of GS1. 00:32:18.239 --> 00:32:22.789 Parliamentary debates about the quality of public services to deaf people are all too 00:32:22.789 --> 00:32:28.330 infrequent. Therefore, like the noble Baroness, Lady Howe, I welcome the opportunity to put 00:32:28.330 --> 00:32:34.320 that right tonight. As noble Lords have said, it is particularly opportune because of the 00:32:34.320 --> 00:32:40.889 publication on 25 March of this excellent report by the deaf health charity SignHealth. 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. 00:32:47.700 --> 00:32:53.779 As my noble friend said, the report makes very sobering reading. He went through some 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 00:33:02.169 --> 00:33:07.700 service-underdiagnosis, poorer treatment, poorer communication and lack of accessible 00:33:07.700 --> 00:33:14.700 health information-are a salutary wake-up call to us all. As the noble Baroness, Lady 00:33:15.599 --> 00:33:22.599 Howe, said, this has been reinforced by some interesting work by local Healthwatches, which 00:33:22.929 --> 00:33:29.919 we were sent over the weekend. The noble Baroness referred to Kirklees Healthwatch, but I also 00:33:29.919 --> 00:33:36.919 notice work in York, Wakefield, Staffordshire, Enfield, Islington and Stockport. All of those 00:33:37.359 --> 00:33:44.259 local Healthwatches are doing good work in their areas. I hope that the Government will 00:33:44.259 --> 00:33:51.259 listen to what Healthwatch is saying and act on some of its recommendations and proposals. 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 00:34:01.129 --> 00:34:07.519 around, such as communications agreements for each deaf person coming into contact with 00:34:07.519 --> 00:34:14.179 the health service. It is surely a sensible recommendation that they should be able to 00:34:14.179 --> 00:34:21.179 book appointments online using SMS text to communicate with services. Also, health information 00:34:21.980 --> 00:34:28.100 needs to be more accessible in other formats, including British Sign Language and subtitles. 00:34:28.100 --> 00:34:33.889 Importantly, there is the recommendation on psychological therapies, which ought to be 00:34:33.889 --> 00:34:40.480 available to deaf people in British Sign Language nationwide. It has been reported to us that 00:34:40.480 --> 00:34:47.480 Ministers have turned that recommendation down. I would be grateful if the Minister 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 00:34:58.790 --> 00:35:05.790 is consistent with the Equality Act duty? I want to ask the Minister about this more 00:35:08.150 --> 00:35:15.150 generally. She knows that individual National Health Service bodies and the department's 00:35:15.720 --> 00:35:22.720 arm's-length bodies have public sector equality duties under Section 149 of the Equality Act 00:35:23.150 --> 00:35:30.150 2010. This duty requires public authorities to have due regard to eliminate discrimination 00:35:31.810 --> 00:35:37.490 between those with and without a protected characteristic and to advance equality of 00:35:37.490 --> 00:35:43.180 opportunity between those with and without a protected characteristic. My understanding 00:35:43.180 --> 00:35:49.080 is that that means removing or minimising disadvantages suffered by people in protected 00:35:49.080 --> 00:35:55.070 groups and considering steps to meet the needs of protected groups where they are different 00:35:55.070 --> 00:36:01.670 from those of other people. Public authorities are also under a duty to make reasonable adjustments 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 00:36:07.630 --> 00:36:14.630 possible to the standard usually offered to non-disabled people. From the SignHealth work, 00:36:16.170 --> 00:36:23.170 it is pretty apparent that for many deaf people that duty is not being effectively applied. 00:36:29.230 --> 00:36:36.230 Again, what action are the Government taking to monitor the implementation of the Act's 00:36:36.330 --> 00:36:43.330 duty and what action will they take if it is clear that public authorities are failing 00:36:43.880 --> 00:36:50.110 in that duty? We have had some debate about the necessity 00:36:50.110 --> 00:36:57.110 of interpreting services. I have been contacted by a general practitioner who is particularly 00:36:57.910 --> 00:37:04.910 concerned about this issue. She tells me that there is currently confusion in the NHS about 00:37:05.830 --> 00:37:12.290 the funding for interpreters since the reorganisation and replacement of primary care trusts by 00:37:12.290 --> 00:37:19.140 clinical commissioning groups. My understanding is that in many parts of the country primary 00:37:19.140 --> 00:37:26.140 care trusts funded interpreting services but, since they were abolished, there seem to be 00:37:27.860 --> 00:37:32.910 two problems. One is that clinical commissioning groups have not always been prepared to continue 00:37:32.910 --> 00:37:39.910 to fund those services. Secondly, there has been the issue of how GPs might obtain funding 00:37:41.020 --> 00:37:47.070 from NHS England, which is the body that they are now in contract with, for interpreting 00:37:47.070 --> 00:37:54.070 services within their own surgeries. I understand that, while at first some GPs were successful, 00:37:55.210 --> 00:38:01.140 there are indications that funding is now being withdrawn. That means that GPs will 00:38:01.140 --> 00:38:08.140 have to pay for interpreting services out of their practice expenses. Again, I would 00:38:09.270 --> 00:38:15.520 be interested in what the Minister has to say about that. 00:38:15.520 --> 00:38:20.740 The noble Lord, Lord Borwick, made an interesting speech and I certainly take his point about 00:38:20.740 --> 00:38:27.670 literacy and the achievement of the cochlear implant programme. However, I was delighted 00:38:27.670 --> 00:38:33.470 with the official recognition of British Sign Language some years ago. I recall the bad 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 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 00:38:46.830 --> 00:38:53.280 interpreters are available in the NHS. I also share his concern-he raised the point that 00:38:53.280 --> 00:38:59.530 we debated in October-about whether enough people are coming forward to train as teachers 00:38:59.530 --> 00:39:02.520 of deaf children. That is a very important point. 00:39:02.520 --> 00:39:07.460 I very much take the point raised by the noble Lord, Lord Addington, about online interpretation. 00:39:07.460 --> 00:39:14.460 He was really saying that that solution was capable of a much wider interpretation than 00:39:16.210 --> 00:39:23.210 simply talking about deaf people themselves. We must surely be on the edge of a revolution 00:39:24.650 --> 00:39:31.650 in communications and the use of IT in the health service. This could clearly bring great 00:39:34.130 --> 00:39:39.700 advantages for many people who find communications difficult at the moment, but I do not think 00:39:39.700 --> 00:39:44.120 it takes away the responsibility of people in the health service to improve the way they 00:39:44.120 --> 00:39:51.120 do things now. It is very clear that some deaf people are finding services very inaccessible 00:39:51.260 --> 00:39:56.800 indeed. I totally agree with the noble Lord: it is 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 00:40:04.330 --> 00:40:11.090 that the noble Lord has put forward. I welcome the suggestions that he made. 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 00:40:17.650 --> 00:40:24.650 forward a number of proposals for the Government to consider. For many years, the outcome of 00:40:25.950 --> 00:40:31.620 health services for deaf people has been overlooked. We are talking about a relatively small group 00:40:31.620 --> 00:40:38.620 of people-people who inevitably find communication difficult. Will the Government consider the 00:40:42.730 --> 00:40:49.730 appointment of a national champion-perhaps a national clinical director-to champion health 00:40:50.140 --> 00:40:56.430 services for deaf people? The clinical directors that the department and NHS England have taken 00:40:56.430 --> 00:41:02.200 on have been outstanding in giving leadership in relation to a number of clinical areas. 00:41:02.200 --> 00:41:08.230 I wonder whether, for deaf people in particular, having a champion at national level could 00:41:08.230 --> 00:41:15.090 help disseminate information and really bang heads together to ensure that much more focus 00:41:15.090 --> 00:41:22.090 is given to the needs of these people. Secondly, will the Minister encourage Healthwatch 00:41:22.170 --> 00:41:28.790 to continue to build on its work to give specific focus on services for deaf people? 00:41:28.790 --> 00:41:33.960 Thirdly, will the Minister encourage health and well-being boards at local level to pick 00:41:33.960 --> 00:41:40.960 up our concerns about across-the-board services? The noble Lord, Lord Addington, made a very 00:41:41.130 --> 00:41:46.350 strong point about the role of the Minister for the Disabled at national level. At local 00:41:46.350 --> 00:41:52.450 level, the health and well-being boards could clearly carry out that same function. 00:41:52.450 --> 00:41:58.140 Fourthly, will the Minister encourage the development of clinical networks in each local 00:41:58.140 --> 00:42:04.080 health area so that there is co-ordination of services across primary, secondary and 00:42:04.080 --> 00:42:07.760 tertiary care as regards the needs of deaf people? 00:42:07.760 --> 00:42:14.760 Finally, will the Minister institute regular meetings between deaf organisations and the 00:42:15.030 --> 00:42:21.050 NHS within each local health area so that there can be proper discussion and debate 00:42:21.050 --> 00:42:26.340 about the needs of deaf people? This is a very important debate and I am sure 00:42:26.340 --> 00:42:31.200 that we all look forward to a positive response from the Minister. 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, 00:42:41.810 --> 00:42:47.590 and I welcome the opportunity to discuss the serious concerns that he raises. This has 00:42:47.590 --> 00:42:54.280 been a really good, well informed debate and many excellent questions have been asked. 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 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, 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 00:43:11.820 --> 00:43:15.650 anything that I have not covered. I would also like to take this opportunity 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 00:43:20.780 --> 00:43:27.310 access to healthcare and better health outcomes for deaf people. The findings outlined in 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 00:43:33.630 --> 00:43:38.860 to have undiagnosed conditions such as high blood pressure and diabetes and that they 00:43:38.860 --> 00:43:45.850 are more likely to receive inadequate treatment when they are diagnosed, is completely unacceptable. 00:43:45.850 --> 00:43:49.840 This Government are committed to delivering health outcomes that are among the best in 00:43:49.840 --> 00:43:55.680 the world for people with hearing loss. Before getting to the main issue of the health 00:43:55.680 --> 00:44:00.860 of the deaf population, I would like to spend a few seconds outlining service improvements 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 00:44:06.500 --> 00:44:12.650 programme for newborn children; significantly reduced waiting times for assessment and treatment, 00:44:12.650 --> 00:44:18.030 with almost all patients now treated within 18 weeks, with the average being four and 00:44:18.030 --> 00:44:23.490 a half weeks; and greater choice of hearing aid services-for example, through independent 00:44:23.490 --> 00:44:29.170 high street providers. In particular, by taking forward measures which enable the early identification 00:44:29.170 --> 00:44:36.170 of deafness, we are able to provide a clear care pathway for services and enable parents 00:44:36.520 --> 00:44:40.860 to make informed choices on communication needs. 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 00:44:46.850 --> 00:44:53.540 deaf patients. Small adjustments could make a real difference by enabling those with hearing 00:44:53.540 --> 00:45:00.300 loss to communicate with their health providers. Have services thought about how deaf patients 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 00:45:06.040 --> 00:45:09.530 appointment, will they know when their name is called or will they be left sitting in 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 00:45:15.660 --> 00:45:22.660 to communicate with them? I am sure that SignHealth would readily identify with the questions 00:45:25.800 --> 00:45:28.780 I have posed. The noble Lord, Lord Addington, talked about 00:45:28.780 --> 00:45:34.120 the use of technology in communication, and he brings his personal knowledge to bear. 00:45:34.120 --> 00:45:41.120 Online signing is something that might be sensible, and an intelligent use of services 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- 00:45:48.770 --> 00:45:55.060 is the co-commissioning of these sorts of services. That sort of approach would not 00:45:55.060 --> 00:46:02.060 only give patients their dignity but also help make the GP's job more straightforward. 00:46:05.810 --> 00:46:12.810 The noble Baroness, Lady Howe of Idlicote, urged noble Lords to carry out checks in their 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 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 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 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! 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 00:46:43.770 --> 00:46:49.030 well with deaf people and there is no reason why they should not be replicated throughout 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 00:47:00.290 --> 00:47:05.550 just do not know. There are currently over 10 million adults 00:47:05.550 --> 00:47:11.360 in England living with hearing loss; the World Health Organisation estimates that by 2030 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 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 00:47:24.150 --> 00:47:30.120 in order to promote good health and address their health needs. All options should be 00:47:30.120 --> 00:47:36.970 considered. The noble Lord, Lord Hunt, told the House about the public sector equality 00:47:36.970 --> 00:47:42.910 duty. This requires all public bodies, including those who provide health and social care, 00:47:42.910 --> 00:47:47.280 to, "advance equality of opportunity" and to, 00:47:47.280 --> 00:47:51.370 "have due regard to the need to eliminate discrimination". 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 00:47:57.450 --> 00:48:02.910 to complain when a service provider has not taken their particular needs into account. 00:48:02.910 --> 00:48:08.850 However, it is up to the service providers to anticipate the requirements of disabled 00:48:08.850 --> 00:48:15.490 people and the reasonable adjustments that may have to be made for them in advance, before 00:48:15.490 --> 00:48:21.520 any disabled person attempts to access their service. The reasonable-adjustment duty is 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 00:48:28.290 --> 00:48:35.290 provide communication support for those who need it. This may involve the use of British 00:48:38.980 --> 00:48:45.120 Sign Language, but it may also involve the use of basic technology such as display screens 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 00:48:51.340 --> 00:48:57.950 Lords referred to that-as all of us become increasingly reliant upon this and other electronic 00:48:57.950 --> 00:49:02.640 forms of communication. My noble friend Lord Borwick talked about 00:49:02.640 --> 00:49:09.640 skills possibly being superseded by technology and referred to cochlear implants, texts and 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 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 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 00:49:34.460 --> 00:49:41.030 are deaf or have hearing loss. This will not be an instant fix. 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. 00:49:48.540 --> 00:49:54.820 As part of the commitment to improve the experience of patients using NHS services and empower 00:49:54.820 --> 00:50:01.820 people to be equal partners in their own care, NHS England is developing an information standard 00:50:01.860 --> 00:50:07.630 for the provision of accessible, personalised information. The standard will ensure that 00:50:07.630 --> 00:50:14.630 disabled patients, service users and carers receive information from NHS bodies and providers 00:50:14.670 --> 00:50:21.670 of NHS care in formats that they can understand. It also requires that they receive appropriate 00:50:21.720 --> 00:50:28.720 support to enable them to communicate with service providers. Successful implementation 00:50:29.210 --> 00:50:34.870 of this information standard will improve the health outcomes and experience of disabled 00:50:34.870 --> 00:50:40.700 people. It will also reduce the number of appointments and screening opportunities missed 00:50:40.700 --> 00:50:47.440 by patients who have received invitations or information in formats that are inappropriate 00:50:47.440 --> 00:50:54.440 for them. It is intended that the standard will be finalised in late 2014, with organisations 00:50:55.130 --> 00:51:02.130 required to comply in 2015. Alongside the statutory information standard, NHS England 00:51:03.740 --> 00:51:09.230 will publish guidance on making reasonable adjustments to meet the communication needs 00:51:09.230 --> 00:51:16.230 of service users with disabilities. We know that there is a need to improve both 00:51:16.530 --> 00:51:20.890 the commissioning and integration of health and social care services for people with hearing 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 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 00:51:34.150 --> 00:51:40.020 actions that will make a real difference to health and social care outcomes for children, 00:51:40.020 --> 00:51:45.820 young people and adults with hearing loss. NHS England is currently engaging with a range 00:51:45.820 --> 00:51:51.550 of stakeholders, including the Department of Health, Public Health England, other government 00:51:51.550 --> 00:51:57.400 departments and agencies and key stakeholders, and aims to publish the action plan as soon 00:51:57.400 --> 00:51:58.110 as possible. 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 00:52:05.260 --> 00:52:12.000 to promoting the needs of deaf people across a range of public services but, in particular, 00:52:12.000 --> 00:52:17.400 ensuring that deaf people have equal access to health and social care and improved outcomes 00:52:17.400 --> 00:52:24.400 equal to people who do not have hearing loss. Equality is the watchword. 00:52:26.840 --> 00:52:33.180 To answer noble Lords' questions, the noble Lord, Lord Hunt, asked about the decision 00:52:33.180 --> 00:52:38.490 on psychological therapy provided in British Sign Language and where the responsibility 00:52:38.490 --> 00:52:45.490 for that should be in specialised commissioning. Following advice from the prescribed specialised 00:52:46.020 --> 00:52:52.230 services advisory group, and in consultation with NHS England, Ministers have taken the 00:52:52.230 --> 00:52:58.100 decision that responsibility for commissioning psychological therapies for deaf sign language 00:52:58.100 --> 00:53:02.510 users should remain with the clinical commissioning groups. 00:53:02.510 --> 00:53:09.510 The noble Lord, Lord Hunt, also made five points. There was that of the national champion 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 00:53:19.620 --> 00:53:25.170 him. On health and well-being boards, they should pick up across-the-board services. 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 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 00:53:37.260 --> 00:53:43.920 not doing so already. On co-ordination of services, again, it should be within the gift 00:53:43.920 --> 00:53:48.330 of health and well-being boards to ensure that social care and all health services are 00:53:48.330 --> 00:53:55.330 not only properly commissioned but also properly co-ordinated. It sounds an admirable idea 00:53:56.140 --> 00:54:00.270 that there should be regular meetings with the NHS in each local area for people with 00:54:00.270 --> 00:54:07.270 hearing loss and deafness. I imagine many people with other sorts of disability would 00:54:07.770 --> 00:54:11.440 like to see that as well. Perhaps that is something that Healthwatch might be able to 00:54:11.440 --> 00:54:16.120 facilitate. 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 00:54:21.860 --> 00:54:27.780 for ensuring that they make reasonable adjustments to meet the needs of disabled people. This 00:54:27.780 --> 00:54:32.990 is not funded centrally but must be found from within local budgets. 00:54:32.990 --> 00:54:39.770 The noble Lord, Lord Addington, asked about co-ordinating help for deaf people in other 00:54:39.770 --> 00:54:45.110 fields, such as education and employment. The Minister of State for Disabled People, 00:54:45.110 --> 00:54:52.110 in his capacity as chair of the interdepartmental group on disability, recently wrote to Ministers 00:54:52.800 --> 00:54:58.470 in other government departments to ask what their departments are doing to support their 00:54:58.470 --> 00:55:05.470 deaf users. On the questions of the noble Lord, Lord Ponsonby, 00:55:06.220 --> 00:55:13.220 about plans to ensure that NHS Choices increases the number of videos available in BSL, NHS 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 00:55:21.490 --> 00:55:26.290 funding for the existing BSL videos. Noble Lords might be interested to know that there 00:55:26.290 --> 00:55:31.950 are videos available on: breast cancer, diabetes, heart disease, lung cancer, prostate cancer, 00:55:31.950 --> 00:55:38.680 back pain, depression and low mood, getting tested for Chlamydia, preventing high cholesterol 00:55:38.680 --> 00:55:42.950 and tinnitus. Those are the ones currently signed. 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 00:55:50.930 --> 00:55:56.090 that no interpreter is available? We recommend that they lodge a formal complaint with the 00:55:56.090 --> 00:56:01.760 GP practice. If the complaint is not resolved, we recommend that the complaint is escalated 00:56:01.760 --> 00:56:08.760 to CCG or NHS England as set out in the complaints procedure. 00:56:10.869 --> 00:56:14.630 What does the Minister think would be the best way to raise deaf awareness among staff 00:56:14.630 --> 00:56:19.950 working in the health service? It is ultimately the responsibility of individual employers 00:56:19.950 --> 00:56:25.410 to support the development of the staff they employ. However, Health Education England 00:56:25.410 --> 00:56:30.060 will provide leadership and work with local education training boards-LETBs-regulatory 00:56:30.060 --> 00:56:36.760 bodies and health care providers to ensure professional and personal development continues 00:56:36.760 --> 00:56:40.650 beyond the end of formal training. 00:56:40.650 --> 00:56:46.119 What steps will the Government take to encourage NHS England and Public Health England to promote 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 00:56:52.600 --> 00:56:58.780 England is under specific legal duties in relation to tackling health inequalities and 00:56:58.780 --> 00:57:05.050 advancing equality. The Government will hold NHS England to account for how well it discharges 00:57:05.050 --> 00:57:07.840 these duties. 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 00:57:13.340 --> 00:57:19.810 and which services they are accessing? The short answer is regrettably no, not yet. However, 00:57:19.810 --> 00:57:26.369 the new system being commissioned by NHS England to upgrade the hospital episodes statistics-the 00:57:26.369 --> 00:57:33.369 HES service-will mean that they include a richer source of hospital data, plus data 00:57:33.610 --> 00:57:39.210 from care provided outside hospital. While this will not tell us how many deaf people 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 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. 00:57:53.369 --> 00:57:57.850 Will implementation of the proposed information standard be supported by a funded programme 00:57:57.850 --> 00:58:03.640 which can help to educate and support? As part of the engagement activity, we asked 00:58:03.640 --> 00:58:10.369 health and care professionals and organisations to advise us as to the challenges they experience 00:58:10.369 --> 00:58:15.550 in meeting the communication needs of patients, carers and services users, as well as the 00:58:15.550 --> 00:58:22.550 ways they have identified to overcome the challenges. These will be reviewed. The intention 00:58:22.980 --> 00:58:28.220 is that the findings will inform the drafting of the standard itself and the development 00:58:28.220 --> 00:58:33.869 of supporting tools. Regarding the psychological therapies question, following a device from 00:58:33.869 --> 00:58:40.869 the prescribed specialised services group, Ministers have decided that these services 00:58:45.770 --> 00:58:48.110 should be commissioned by CCGs. 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 00:58:55.100 --> 00:58:59.520 more teachers to work in this specialist area? Schools and local authorities are responsible 00:58:59.520 --> 00:59:05.790 for assessing their workforce and have adequate recruitment and training strategies in place. 00:59:05.790 --> 00:59:11.980 We expect authorities to work with schools so that they know and build the appropriate 00:59:11.980 --> 00:59:17.690 skills for the teaching workforce, and the DfE is funding scholarships for teachers to 00:59:17.690 --> 00:59:24.690 develop their knowledge and skills, including postgraduate qualifications. Regarding the 00:59:25.690 --> 00:59:32.690 question of texting information, this sort of thing is a local decision. I have told 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. 00:59:41.270 --> 00:59:48.270 On teacher numbers, so far 600 teachers have achieved or are working towards a qualification 00:59:49.110 --> 00:59:54.750 relating to special education needs, and a further 500 have applied for the current funding 00:59:54.750 --> 01:00:01.750 round. I have exhausted the supply of responses from the Dispatch Box, but I feel absolutely 01:00:05.070 --> 01:00:12.070 sure that when we go through Hansard, many more questions that will come to light, so 01:00:12.840 --> 01:00:19.840 we will write a letter to all noble Lords who have taken part in the debate.