How will the government improve the health of deaf people? | House of Lords debate 31 March 2014

Lord Ponsonby of Shulbrede

My Lords, I open by thanking the Minister
and noble Lords who are going to take part

in this important debate. It is about deaf
people, by which I mean people who are born

or become profoundly deaf before the age of
five. They usually prefer to communicate in

British Sign Language and see themselves as
part of the deaf community. By this definition,

there are an estimated 70,000 deaf people
in the United Kingdom.

I am speaking to a deaf health study called
Sick of It, launched last week, on 25 March,

which is the largest and most extensive study
of the health of deaf people in the world

so far. Most of the study was funded by the
Big Lottery Fund and carried out by the charity

SignHealth in partnership with the University
of Bristol. I am particularly indebted to

Dr Andrew Alexander, SignHealth's medical
director, who provided me with the briefing

for this debate.

Before now, there has never been any research
on this scale into the health of deaf people

in this country.
Although there have been a few small studies

looking at access to health-all found it poor-no
Government have ever specifically addressed

the health of deaf people as I have defined
them here. The closest initiative was Mental

Health and Deafness-Towards Equity and Access.
Although this started as a consultation on

mental health, it included a lot on the wider
barriers faced by deaf people. The report

was supported by funding which was received
by each primary care trust to help it implement

the recommendations of the report.

Deaf health rarely features on any agenda,
with the notable exception of that of the

House of Lords. Even within health and equality
programmes, attention is normally focused

on groups with a higher profile. It does not
help that being deaf is a hidden disability

and that there is so little awareness of the
barriers that deaf people face. This is usually

the case on the health front line as well.
Most staff will think that speaking louder

or writing things down will solve the problem.
When surveyed, a very high percentage of doctors

wrongly thought that they had communicated
well with their deaf patients.

I turn to the report's methodology and findings.
There were three stages to the report: first,

an online survey was conducted by Ipsos MORI;
secondly, personal health assessments were

made of 298 deaf people, including looking
at their blood pressure and BMI and taking

blood tests, et cetera; thirdly, there were
in-depth interviews of deaf people. The findings

were as follows. First, underdiagnosis and
undertreatment of potentially serious conditions

was more common for deaf people. Secondly,
high blood pressure was almost twice as common

in deaf people as in the rest of the population.
Thirdly, deaf people have generally healthier

lifestyles than the rest of the population
in terms of smoking and alcohol but are more

likely to be overweight. Fourthly, there is
underdiagnosis: deaf people are twice as likely

as hearing people to have high blood pressure
that has not been diagnosed and may also be

more likely to have undiagnosed diabetes,
high cholesterol and cardiovascular disease.

Moving on to poorer treatment, the report
also found that when deaf people have been

diagnosed, they are more likely to be on inadequate
treatment for those conditions. It has been

estimated that if the deaf community had the
same health profile as the general population,

the NHS would save about £30 million per
year.

I will now talk about access and communication.
A large number of deaf people reported not

seeing their GP because they were put off
by the prospect of poor communication. A large

proportion booked appointments by going to
the practice in person-some 45%-whereas very

few hearing people book appointments in this
way. Only 15% of deaf people said that their

GP was good at listening to them, compared
to 51% of the general population. At most,

30% could use BSL in a consultation even though,
in total, 94% would prefer to sign. More than

half had to use an English-based form of communication-for
example, lip reading or writing notes-but

only 5% would prefer to communicate in that
way. This disparity between how deaf people

have to communicate and how they would like
to communicate is an indictment of the health

service, and an explanation for the poorer
health outcomes of deaf people. Only 25% of

deaf people have confidence in their doctor,
compared to 67% of the general population.

There is also a wider issue about access to
information. Because health information is

not widely available in an accessible format,
a lot of the deaf people studied were unsure

about their health and unsure what their prescriptions
were for or how to take their medicine. While

many hearing patients would find out more
information from friends, family or the internet,

these options were less available to deaf
patients. As a result, few of the deaf people

interviewed through the in-depth process appeared
actively engaged with their own personal health

management.

What are the prescriptions for change? I should
just say that change from the point of view

of the deaf community is about equal rather
than special treatment.

The first prescription is that systems within
the health service need to be accessible.

From booking an appointment to getting test
results, there should be a communication agreement

for each deaf patient, which is then coded
and recorded in their patient record. Secondly,

deaf patients should be able to book appointments
online and be able to use texts to communicate

with services. Thirdly, deaf patients should
be able to communicate during consultations

in their preferred language. Health services
must
expect and plan for deaf patients. Clinicians

should remember that interpreters are not
just for deaf people but help the doctor to

understand and diagnose properly. Fourthly,
providers must make sure that staff know how

to book an interpreter and ensure that interpreters
are suitably qualified. Fifthly, health information

needs to be made accessible in other formats,
including BSL and subtitles. Currently, only

10 out of a total of 900 NHS Choices videos
are available in BSL. The proposed information

standard on accessibility should be supported
with a funded programme.

I move on to some questions, which I have
given notice of to the Minister. First, are

there any plans to ensure that NHS Choices
increases the number of videos available in

BSL? Secondly, what would the Minister recommend
to a deaf person who wants to see a doctor

but is told no interpreter is available or
that it is too expensive? It was brought to

my attention earlier today by Dr Clare Redstone,
a GP, that it is very common to experience

problems in booking interpreters. Thirdly,
what steps will the Government take to encourage

the NHS Executive and Public Health England
to promote the health of deaf people? Fourthly,

when can we expect the NHS computer system
to be able to tell us how many deaf people

there are and which services they are accessing?
Fifthly, will implementation of the proposed

information standard be supported with a funded
programme which can help to educate and support

health services?

My sixth question is one that I sent the Minister
earlier regarding whether psychological therapies

providing BSL should be the responsibility
of specialised commissioners. I understand

that the Minister has since decided that psychological
therapies for deaf people should not be on

the list of prescribed services. Therefore,
in the updated situation, my question is:

how can we ensure that psychological services
nationwide are available for deaf people?

I understand that there is a very patchy covering
at the moment. Lastly, what does the Minister

think would be the best way to raise deaf
awareness among staff working in the health

service?

I look forward to the Minister's response.
I understand that she is working on a cross-governmental

strategy on hearing loss and that the report
on this is ongoing. My debate today is about

a very specific cohort within that deaf community,
and I hope that she will be able to address

the questions that I have raised.

My Lords, I am grateful to the noble Lord,
Lord Ponsonby, for bringing this matter to

debate following the SignHealth report.

I must, first, declare an interest. For about
the past 25 years, I have been a trustee of

the Ewing Foundation for deaf children, a
charity that has, for the past 60 years, helped

to improve the teaching of children who use
their residual hearing and lip reading to

communicate by speech.

The change in the prospects and outcomes for
deaf children due to the introduction of cochlear

implants, digital hearing aids and newborn
hearing screening is one of the most exciting

stories in disability. Noble Lords may have
seen the publicity in the papers on Friday,

or even the YouTube film, of the joy of a
deaf girl of 40 hearing for the first time

when her cochlear implants were turned on.
For the first time, she can hear music, the

laughter of babies and the songs of birds.
This revolution has come from cochlear implants,

which will radically reduce the disabling
effects of profound deafness in children and

adults.

The Sick of It report is important and interesting,
but I am afraid that it gives away its self-selected

background. A statistic on the page about
communication issues claims that 80% of deaf

people want to communicate using British Sign
Language. The noble Lord suggested that that

figure was 93%, but I think it is the definition
of "deaf" that accounts for the difference.

That statistic is a conundrum to me, in that
the vast majority of deaf people, using a

more ordinary definition of the word, are
elderly people who do not use British Sign

Language. Indeed, the CRIDE report said that
79% of deaf children use only spoken English.

It may be that the definition of deaf depends
on who is hearing it.

A strong part of good communication is literacy.
Unfortunately, communicating through sign

language while learning to read and write
in English is like talking in English and

reading and writing in Chinese. I am filled
with admiration for all the children who can

do it. Noble Lords may have strong opinions
about whether tweeting and texting can really

be described as literature but they are fundamental
to the lives of many teenagers nowadays. There

is some great technology coming forward. The
Apple digital assistant, Siri, and many other

programs can transcribe your questions, and
a doctor's replies can be sent from an iPad

to a simultaneous remote caption service.
All these new technologies need literacy.

The theme of the report is that good communication
is fundamental to good health, and that makes

sense, but it is true not only of deaf patients;
communication with all patients can be made

better.

Another feature of the report is isolation,
and deafness is very isolating. Research has

shown that in old age the combination of cognitive
decline and hearing loss can be fatal. Hearing

loss seems to speed up dementia, so perhaps
hearing loss in older patients should be treated

more aggressively when it is first diagnosed,
and deaf awareness training given to more

health professionals.

Time after time, surveys suggest that there
is a correlation between good health and good

education, so the most powerful advantage
to the health of deaf people is to make sure

that they get a great education. Profoundly
deaf children now, thanks to cochlear implants,

can be educated primarily in mainstream schools,
with hearing friends and ordinary prospects

for the future.

But cochlear implants are expensive, although
not so much in their implantation, which,

like everything electronic, is improving technically
and reducing in price. The real cost comes

in training the baby or the child who needs
to get the most out of their implant. However,

this is so much cheaper than a lifetime of
interpreters. I must compliment all parties

for getting on with the cochlear implant programme
and not stinting on this project. Ten thousand

people have had cochlear implants so far.
That is a marvellous achievement and it is

changing society. There are now only a very
small number of children below the age of

five who use sign language, and BSL may be
regarded in the future as being used by fewer

and fewer deaf people. Who knows what will
happen? Many other skills have been superseded

by technology. We will have to do our best
to support those who continue to use sign

language but they will gradually become a
tiny minority of deaf people.

Some 40% of deaf children have disabilities
in addition to hearing loss. Deafness and

autism or deaf and blind with a learning disability
are combinations that are becoming more common,

partly as a function of doctors saving extremely
premature babies who in past years would have

died. These babies can now survive at 22 weeks'
gestation, but with multiple problems. Some

parents are better than others at caring for
a child with challenging behaviour who may

never live independently but, sadly, some
children are effectively abandoned by their

parents to the state-a sad future for a child
following heroic efforts to save an extremely

short pregnancy.

I have two questions for the Minister. The
first concerns the reducing number, and increasing

age profile of, qualified teachers of the
deaf. The report stresses the importance of

good health education for deaf people. Deaf
children and young people need to be equipped

with information and strategies to access
health services independently as adults. To

achieve that, we will need more teachers of
the deaf. How can we get them?

The noble Baroness was asked a very similar
question in a debate last October by my noble

friend Lady Brinton, and she replied with
information about the national scholarship

fund. How many teachers have applied for,
and how many have been granted, help from

this fund to train as teachers of the deaf?
It appears that this fund is not working well

enough to solve the problem, so what else
can be done to encourage more teachers to

work in this specialist area?

Secondly, can we increase the amount of communication
in our health service that is duplicated both

verbally and by text? It is far cheaper to
have a text system of booking appointments

than an interpreter, and that expenditure
will benefit not only deaf patients but all

patients who can read and write in English.

My Lords, having seen the title of the SignHealth
report, I was surprised by nothing that I

read in it. If you think about it, when you
are dealing with a medical situation, being

able to tell somebody what the matter is has
to be a huge advantage. Man as an animal is

supposed to be a compulsive communicator.
One major thing that we do is to talk to each

other and if something gets in the way of
being able to communicate properly, we will

have problems. The question is: how do we
deal with that? We will never get it absolutely

right.

I have to declare an interest. I am chairman
of a company called Microlink, which supports

disabled people through its innovations, usually
involving computing. This has led me to take

a closer look at this area. Indeed, one of
our case studies concerned being an online

interpreter. Most of us are online. It is
a much better use of an interpreter's time

to be able to use British Sign Language online
than it is for him or her to have to follow

a person around.

In addition, if we are supposed to be enhancing
the dignity of a person, we want to give them

as much independence as possible. A translator
is an expensive, difficult piece of kit you

may not want in the room when you are talking
to your doctor about, for example, sexual

health or reproduction, particularly if they
are there all the time. Having something online,

as described here, seems a perfectly sensible
way forward but to use it both parties must

know that it is possible and how to access
it. Making sure that that information is discerned

throughout the system for the client base
and the provider is essential to getting the

best out of it. That must be looked at and
people must know it is available. If it can

be done comparatively easily, which seems
to be the case, everyone must know. That would

enhance the dignity of the patient and make
the job of the doctor easier. We can go into

the night speaking about that.

As the noble Lord, Lord Borwick, has mentioned,
lots of technologies are language-based. If

you are literate, you would have another means
of communication. As someone who is dyslexic,

I have a little story about one of these bits
of technology. Through the aforementioned

interest, I saw a wonderful piece of kit which
addresses literacy and gives a person some

personal space. The UbiDuo comes from the
States, although I do not think that we would

have given it that name. Basically, you use
two keyboards and two screens that are roughly

the size of small computers, and you get instant
translation of your communication to someone

else. They can read it and communicate back.
I was shown this at a conference where everyone

else was oohing and ahing about it. I discovered
that I was the only person who could not use

it because I am dyslexic, which shows that
everything has its limitations. However, if

you are informed and know what is going on,
you can overcome that and get through to the

other person. A line of communication can
be established. There are many different types

and uses of language. If we can establish
the fact that they are available and known

about, these problems will be cut.

Most of what we are talking about will cut
across government departments. How would anything

being talked about here not be covered in
one's health employment profile? I bumped

into Mike Penning, the disability Minister,
who said that he is going to try to work across

departments. It is nice to know that disability
has been slightly pushed up and now has a

Minister of State. There will be the same
problems in health, employment and education.

Everything relates and cross-references. How
we deal with that is very important.

When someone leaves a medical establishment,
hospital or doctor's surgery, how will they

interpret the lifestyle and support that they
will receive? I know Mike Penning reasonably

well and he is a tenacious individual but
I do not know how much he and Ministers in

other departments can make sure that this
support is followed through. If deaf people

are overweight and want healthier lifestyles,
it is true that they have more trouble accessing,

for example, exercise and outdoor activity.
What are we doing to make sure that they can

or that they do not have to jump over hurdles?
We should be able to take our solution from

one place to another.

We have just heard a very positive description
of what might happen with cochlea implants.

That will never deal with all the problems
but it might deal with quite a lot of them.

However, as the noble Lord said, most people's
hearing problems are probably late onset.

As with most disabilities, they build up.
The deaf community has vociferous factions

within it which will tell you that true deafness
is something else, that it is what they have

and not what someone else has, and that their
approach and nothing else is the proper one.

They are like all other communities I have
ever met in that regard. However, unless you

can get an approach which covers a variety
of ways of dealing with the communication

problem, addresses all those areas and accepts
that they are all equally valid, you will

always create more holes, cracks and barriers
than you should otherwise have.

Finally, I have a story about the aforementioned
UbiDuo. When Esther McVey was the Minister

for Disabled People, she was at a conference
and decided to have a chat with the deaf man

who was doing a demonstration. After a long
conversation with aides possibly tugging at

her elbow to get her out of the room, we went
along and said, "This is wonderful. Isn't

it a great piece of kit?". A woman from the
next stall said, "I wonder if she would have

been quite so keen if it wasn't such a tall,
good-looking man on the other side". If my

honourable friend had not noticed that, the
woman on the next stall certainly had. Allowing

someone to interact on a basic human level
is what we are after. This is merely an application

that can be used in the healthcare that we
are looking at. Unless we approach it like

that, we will miss far more opportunities
to enhance people's lives overall than we

should.

My Lords, I congratulate the noble Lord, Lord
Ponsonby, on securing this debate on much

needed improvements for the health needs of
deaf people. Although deaf people have the

advantage, unlike the blind, of being able
to see, the fact that deafness is not a visible

disability, as the noble Lord, Lord Ponsonby,
has said, means that other people are not

necessarily aware that you are deaf. Therefore,
less immediate attention is given in trying

to help with any problems that the person
will be facing. Perhaps that lack of awareness

of deafness also helps to explain why so few
Members of your Lordships' House are taking

part in this important dinner-break debate.

As someone who has had hearing problems since
my children were born, and as I have now reached

the limit of what hearing aids can do to help
me understand what people are saying, I have

some, although obviously not a complete, understanding
of the problems and frustrations that deaf

patients face. Most definitely I have sympathy
with the concerns so graphically illustrated

in the pamphlet How the Health Service is
Failing Deaf People. It clearly makes sense

for doctors' surgeries or hospitals to have
the kind of BSL support or other technical

arrangements to hand that the authors of this
pamphlet are advocating should be routine

but clearly are not. Although I suspect that
not everyone who is deaf will mind having

someone close to them speak to the doctor,
the individual's wishes should be paramount.

Surely, it must be of concern to us all that
so many deaf people have a considerably poorer

health record than the average citizen. I
was glad to see from a Healthwatch briefing

sent to me over the weekend that a few areas
of the country are beginning to realise the

extent of the problems that deaf or hard-of-hearing
patients face. In 2013, Kirklees Healthwatch

followed up numerous concerns identified in
its survey of the area. I hope that at least

some of these-for example, deaf awareness
training being developed and rolled out for

provider staff, including handling phone calls,
personal visitors and booking of BSL interpreters-are

beginning to happen. Healthwatch also reports
the beginnings of awareness and action in

areas such as York, Wakefield, Staffordshire
and Stockport. As well as the important reasons

in the pamphlets for the relevant help proposed,
there are other reasons why a greater priority

needs to be given to those who are deaf or
in the process of going deaf. Ageing, by itself,

inevitably brings hearing loss. As people
are living considerably longer these days,

they will have hearing problems for a longer
period of their lives. As well as that, the

way that today's young expose their ears to
incredibly loud media sounds will inevitably

mean that when age kicks in, their hearing
loss is bound to be considerably worse, last

longer and probably start at an earlier age.

Interestingly, in your Lordships' House, despite
all the modern hearing loops that are fitted

in the Committee Rooms, which others may also
have found quite difficult to communicate

with, I find that the very best hearing loops
available are those that we can switch into

in the Chamber in itself-where we are at the
moment. This has a great deal to do with the

considerable improvements that have recently
been completed here, but I suspect that it

is also helped by the way that the microphones
all hang down from the ceiling and speakers

are located in the seats of every Bench for
people to listen through.

As in so many other ways, because so many
noble Lords themselves are going through the

stages of ageing, including hearing loss,
apart from each one of us checking that appropriate

equipment and help are available in our own
doctors' surgeries-which I certainly hope

every one of us here today will do-debates
such as this that seek government backing

can also help to raise awareness of the necessary
action to be taken.

With that in mind, I look forward to what
the Minister can tell us about what the Government

will do to reassure the noble Lord, Lord Ponsonby,
about his six questions and the others that

we have added. These considerable changes
must take place in doctors' surgeries and

hospitals to meet the wide range of needs
described so graphically in the pamphlet,

How the Health Service Is Failing Deaf People.
To continue with such failure would surely

be a disgrace.

My Lords, I am very grateful to my noble friend
Lord Ponsonby for his initiative and his excellent

speech. I declare my interest as chair of
an NHS foundation trust, a consultant and

trainer with Cumberlege Connections and president
of GS1.

Parliamentary debates about the quality of
public services to deaf people are all too

infrequent. Therefore, like the noble Baroness,
Lady Howe, I welcome the opportunity to put

that right tonight. As noble Lords have said,
it is particularly opportune because of the

publication on 25 March of this excellent
report by the deaf health charity SignHealth.

I was very privileged to speak at the conference
held on 25 March to launch the report.

As my noble friend said, the report makes
very sobering reading. He went through some

of the details, but the headline results of
issues in relation to deaf people in the health

service-underdiagnosis, poorer treatment,
poorer communication and lack of accessible

health information-are a salutary wake-up
call to us all. As the noble Baroness, Lady

Howe, said, this has been reinforced by some
interesting work by local Healthwatches, which

we were sent over the weekend. The noble Baroness
referred to Kirklees Healthwatch, but I also

notice work in York, Wakefield, Staffordshire,
Enfield, Islington and Stockport. All of those

local Healthwatches are doing good work in
their areas. I hope that the Government will

listen to what Healthwatch is saying and act
on some of its recommendations and proposals.

My noble friend referred to a number of recommendations
made by SignHealth to try to turn the situation

around, such as communications agreements
for each deaf person coming into contact with

the health service. It is surely a sensible
recommendation that they should be able to

book appointments online using SMS text to
communicate with services. Also, health information

needs to be more accessible in other formats,
including British Sign Language and subtitles.

Importantly, there is the recommendation on
psychological therapies, which ought to be

available to deaf people in British Sign Language
nationwide. It has been reported to us that

Ministers have turned that recommendation
down. I would be grateful if the Minister

could update the House on that. If Ministers
have turned it down, does she think that that

is consistent with the Equality Act duty?
I want to ask the Minister about this more

generally. She knows that individual National
Health Service bodies and the department's

arm's-length bodies have public sector equality
duties under Section 149 of the Equality Act

2010. This duty requires public authorities
to have due regard to eliminate discrimination

between those with and without a protected
characteristic and to advance equality of

opportunity between those with and without
a protected characteristic. My understanding

is that that means removing or minimising
disadvantages suffered by people in protected

groups and considering steps to meet the needs
of protected groups where they are different

from those of other people. Public authorities
are also under a duty to make reasonable adjustments

for disabled people to make sure that a disabled
person can use a service as close as reasonably

possible to the standard usually offered to
non-disabled people. From the SignHealth work,

it is pretty apparent that for many deaf people
that duty is not being effectively applied.

Again, what action are the Government taking
to monitor the implementation of the Act's

duty and what action will they take if it
is clear that public authorities are failing

in that duty?
We have had some debate about the necessity

of interpreting services. I have been contacted
by a general practitioner who is particularly

concerned about this issue. She tells me that
there is currently confusion in the NHS about

the funding for interpreters since the reorganisation
and replacement of primary care trusts by

clinical commissioning groups. My understanding
is that in many parts of the country primary

care trusts funded interpreting services but,
since they were abolished, there seem to be

two problems. One is that clinical commissioning
groups have not always been prepared to continue

to fund those services. Secondly, there has
been the issue of how GPs might obtain funding

from NHS England, which is the body that they
are now in contract with, for interpreting

services within their own surgeries. I understand
that, while at first some GPs were successful,

there are indications that funding is now
being withdrawn. That means that GPs will

have to pay for interpreting services out
of their practice expenses. Again, I would

be interested in what the Minister has to
say about that.

The noble Lord, Lord Borwick, made an interesting
speech and I certainly take his point about

literacy and the achievement of the cochlear
implant programme. However, I was delighted

with the official recognition of British Sign
Language some years ago. I recall the bad

old days when some deaf children were forbidden
to use sign language at school. We have all

moved on from that and, for those deaf people
who use sign language, it is important that

interpreters are available in the NHS. I also
share his concern-he raised the point that

we debated in October-about whether enough
people are coming forward to train as teachers

of deaf children. That is a very important
point.

I very much take the point raised by the noble
Lord, Lord Addington, about online interpretation.

He was really saying that that solution was
capable of a much wider interpretation than

simply talking about deaf people themselves.
We must surely be on the edge of a revolution

in communications and the use of IT in the
health service. This could clearly bring great

advantages for many people who find communications
difficult at the moment, but I do not think

it takes away the responsibility of people
in the health service to improve the way they

do things now. It is very clear that some
deaf people are finding services very inaccessible

indeed.
I totally agree with the noble Lord: it is

another way of skinning the cat-that is all.
The NHS has a long way to go to use the technology

that the noble Lord has put forward. I welcome
the suggestions that he made.

My noble friend Lord Ponsonby asked the Minister
a number of questions. I would like to put

forward a number of proposals for the Government
to consider. For many years, the outcome of

health services for deaf people has been overlooked.
We are talking about a relatively small group

of people-people who inevitably find communication
difficult. Will the Government consider the

appointment of a national champion-perhaps
a national clinical director-to champion health

services for deaf people? The clinical directors
that the department and NHS England have taken

on have been outstanding in giving leadership
in relation to a number of clinical areas.

I wonder whether, for deaf people in particular,
having a champion at national level could

help disseminate information and really bang
heads together to ensure that much more focus

is given to the needs of these people.
Secondly, will the Minister encourage Healthwatch

to continue to build on its work to give specific
focus on services for deaf people?

Thirdly, will the Minister encourage health
and well-being boards at local level to pick

up our concerns about across-the-board services?
The noble Lord, Lord Addington, made a very

strong point about the role of the Minister
for the Disabled at national level. At local

level, the health and well-being boards could
clearly carry out that same function.

Fourthly, will the Minister encourage the
development of clinical networks in each local

health area so that there is co-ordination
of services across primary, secondary and

tertiary care as regards the needs of deaf
people?

Finally, will the Minister institute regular
meetings between deaf organisations and the

NHS within each local health area so that
there can be proper discussion and debate

about the needs of deaf people?
This is a very important debate and I am sure

that we all look forward to a positive response
from the Minister.

My Lords, I thank the noble Lord for securing
this short debate on the health of deaf people,

and I welcome the opportunity to discuss the
serious concerns that he raises. This has

been a really good, well informed debate and
many excellent questions have been asked.

I would point out that my scripted speech
is six-minutes long, so I hope to answer as

many of the other questions as possible within
the rest of the time available to me. However,

in tested and time-honoured tradition, I will
send a letter to all noble Lords to address

anything that I have not covered.
I would also like to take this opportunity

to pay tribute to the work of SignHealth and
the efforts that it has made to achieve equal

access to healthcare and better health outcomes
for deaf people. The findings outlined in

its recent report, Sick of It, are truly shocking.
The fact that deaf people are more likely

to have undiagnosed conditions such as high
blood pressure and diabetes and that they

are more likely to receive inadequate treatment
when they are diagnosed, is completely unacceptable.

This Government are committed to delivering
health outcomes that are among the best in

the world for people with hearing loss.
Before getting to the main issue of the health

of the deaf population, I would like to spend
a few seconds outlining service improvements

to those with hearing loss or who are deaf.
These include the rollout of a national screening

programme for newborn children; significantly
reduced waiting times for assessment and treatment,

with almost all patients now treated within
18 weeks, with the average being four and

a half weeks; and greater choice of hearing
aid services-for example, through independent

high street providers. In particular, by taking
forward measures which enable the early identification

of deafness, we are able to provide a clear
care pathway for services and enable parents

to make informed choices on communication
needs.

However, as SignHealth's report shows, it
is in the most basic way that we are failing

deaf patients. Small adjustments could make
a real difference by enabling those with hearing

loss to communicate with their health providers.
Have services thought about how deaf patients

can book a GP appointment if they cannot just
pick up a telephone? Once they have made an

appointment, will they know when their name
is called or will they be left sitting in

the waiting room? Once they get to see their
GP or hospital clinician, will they be able

to communicate with them? I am sure that SignHealth
would readily identify with the questions

I have posed.
The noble Lord, Lord Addington, talked about

the use of technology in communication, and
he brings his personal knowledge to bear.

Online signing is something that might be
sensible, and an intelligent use of services

such as Skype might also be helpful. Critical
to all of this-and I shall come to it later-

is the co-commissioning of these sorts of
services. That sort of approach would not

only give patients their dignity but also
help make the GP's job more straightforward.

The noble Baroness, Lady Howe of Idlicote,
urged noble Lords to carry out checks in their

own practices. I do not think that anyone
would dare not to do so after that. Certainly

with my own practice in Bodmin, in the heart
of Cornwall, I can book online to see a doctor

or a nurse. When I turn up for a visit I do
not talk to a receptionist, I just press a

touch-screen pad which asks me for my date
of birth and my gender. It then says, "Ah!

Are you Mrs Jolly?", and tells me to sit down
and wait. All those services would work perfectly

well with deaf people and there is no reason
why they should not be replicated throughout

the land. What happens behind the consulting
room door may not be as good as all of that-I

just do not know.
There are currently over 10 million adults

in England living with hearing loss; the World
Health Organisation estimates that by 2030

the figure will rise to 14.5 million. It is
therefore vital that health and social care

services are geared up to be able to communicate
with deaf people and those with hearing loss

in order to promote good health and address
their health needs. All options should be

considered. The noble Lord, Lord Hunt, told
the House about the public sector equality

duty. This requires all public bodies, including
those who provide health and social care,

to, "advance equality of opportunity" and
to,

"have due regard to the need to eliminate
discrimination".

SignHealth's Sick of It report is right to
remind deaf people that they have a right

to complain when a service provider has not
taken their particular needs into account.

However, it is up to the service providers
to anticipate the requirements of disabled

people and the reasonable adjustments that
may have to be made for them in advance, before

any disabled person attempts to access their
service. The reasonable-adjustment duty is

an anticipatory duty, so it is just not acceptable
for health services not to be equipped to

provide communication support for those who
need it. This may involve the use of British

Sign Language, but it may also involve the
use of basic technology such as display screens

in GP waiting rooms. It may also involve something
as simple as text messaging-nearly all noble

Lords referred to that-as all of us become
increasingly reliant upon this and other electronic

forms of communication.
My noble friend Lord Borwick talked about

skills possibly being superseded by technology
and referred to cochlear implants, texts and

the internet. I defy any noble Lord not to
be touched by the moving story of Joanne Milne

as she heard for the first time this week
but a lot of this will take a long time to

roll out. It will take a while before the
youngsters reach the age of older people who

are deaf or have hearing loss. This will not
be an instant fix.

I am happy to be able to report that progress
is being made on the NHS information standard.

As part of the commitment to improve the experience
of patients using NHS services and empower

people to be equal partners in their own care,
NHS England is developing an information standard

for the provision of accessible, personalised
information. The standard will ensure that

disabled patients, service users and carers
receive information from NHS bodies and providers

of NHS care in formats that they can understand.
It also requires that they receive appropriate

support to enable them to communicate with
service providers. Successful implementation

of this information standard will improve
the health outcomes and experience of disabled

people. It will also reduce the number of
appointments and screening opportunities missed

by patients who have received invitations
or information in formats that are inappropriate

for them. It is intended that the standard
will be finalised in late 2014, with organisations

required to comply in 2015. Alongside the
statutory information standard, NHS England

will publish guidance on making reasonable
adjustments to meet the communication needs

of service users with disabilities.
We know that there is a need to improve both

the commissioning and integration of health
and social care services for people with hearing

loss, as well as the provision of new and
innovative models of care. This is why we

are also developing a new action plan on hearing
loss. The action plan will identify the key

actions that will make a real difference to
health and social care outcomes for children,

young people and adults with hearing loss.
NHS England is currently engaging with a range

of stakeholders, including the Department
of Health, Public Health England, other government

departments and agencies and key stakeholders,
and aims to publish the action plan as soon

as possible.

I hope that I have been able to reassure the
House that the Government have a strong commitment

to promoting the needs of deaf people across
a range of public services but, in particular,

ensuring that deaf people have equal access
to health and social care and improved outcomes

equal to people who do not have hearing loss.
Equality is the watchword.

To answer noble Lords' questions, the noble
Lord, Lord Hunt, asked about the decision

on psychological therapy provided in British
Sign Language and where the responsibility

for that should be in specialised commissioning.
Following advice from the prescribed specialised

services advisory group, and in consultation
with NHS England, Ministers have taken the

decision that responsibility for commissioning
psychological therapies for deaf sign language

users should remain with the clinical commissioning
groups.

The noble Lord, Lord Hunt, also made five
points. There was that of the national champion

and how to build on the work thus far. I am
happy to take that back and will write to

him. On health and well-being boards, they
should pick up across-the-board services.

We hope that they are doing so. I suspect
that health and well-being boards will, in

their second report for this coming year,
pick up on that sort of thing if they are

not doing so already. On co-ordination of
services, again, it should be within the gift

of health and well-being boards to ensure
that social care and all health services are

not only properly commissioned but also properly
co-ordinated. It sounds an admirable idea

that there should be regular meetings with
the NHS in each local area for people with

hearing loss and deafness. I imagine many
people with other sorts of disability would

like to see that as well. Perhaps that is
something that Healthwatch might be able to

facilitate.

Do GPs have to pay for their translation services?
Each provider of a public service is responsible

for ensuring that they make reasonable adjustments
to meet the needs of disabled people. This

is not funded centrally but must be found
from within local budgets.

The noble Lord, Lord Addington, asked about
co-ordinating help for deaf people in other

fields, such as education and employment.
The Minister of State for Disabled People,

in his capacity as chair of the interdepartmental
group on disability, recently wrote to Ministers

in other government departments to ask what
their departments are doing to support their

deaf users.
On the questions of the noble Lord, Lord Ponsonby,

about plans to ensure that NHS Choices increases
the number of videos available in BSL, NHS

Choices is very keen to provide more BSL content.
It has approached SignHealth and in turn secured

funding for the existing BSL videos. Noble
Lords might be interested to know that there

are videos available on: breast cancer, diabetes,
heart disease, lung cancer, prostate cancer,

back pain, depression and low mood, getting
tested for Chlamydia, preventing high cholesterol

and tinnitus. Those are the ones currently
signed.

What would the Minister recommend to a deaf
person who wants to see a doctor but is told

that no interpreter is available? We recommend
that they lodge a formal complaint with the

GP practice. If the complaint is not resolved,
we recommend that the complaint is escalated

to CCG or NHS England as set out in the complaints
procedure.

What does the Minister think would be the
best way to raise deaf awareness among staff

working in the health service? It is ultimately
the responsibility of individual employers

to support the development of the staff they
employ. However, Health Education England

will provide leadership and work with local
education training boards-LETBs-regulatory

bodies and health care providers to ensure
professional and personal development continues

beyond the end of formal training.

What steps will the Government take to encourage
NHS England and Public Health England to promote

the health of deaf people? The NHS is a universal
service for the people of England and NHS

England is under specific legal duties in
relation to tackling health inequalities and

advancing equality. The Government will hold
NHS England to account for how well it discharges

these duties.

Can we expect NHS computer systems to be able
to tell us how many deaf people there are

and which services they are accessing? The
short answer is regrettably no, not yet. However,

the new system being commissioned by NHS England
to upgrade the hospital episodes statistics-the

HES service-will mean that they include a
richer source of hospital data, plus data

from care provided outside hospital. While
this will not tell us how many deaf people

there are, it will tell us about deaf people's
access of services. I am sure other improvements

to care data in time will be able to give
us the number of deaf people there are.

Will implementation of the proposed information
standard be supported by a funded programme

which can help to educate and support? As
part of the engagement activity, we asked

health and care professionals and organisations
to advise us as to the challenges they experience

in meeting the communication needs of patients,
carers and services users, as well as the

ways they have identified to overcome the
challenges. These will be reviewed. The intention

is that the findings will inform the drafting
of the standard itself and the development

of supporting tools. Regarding the psychological
therapies question, following a device from

the prescribed specialised services group,
Ministers have decided that these services

should be commissioned by CCGs.

I move on to the question of the noble Lord,
Lord Borwick: what can be done to encourage

more teachers to work in this specialist area?
Schools and local authorities are responsible

for assessing their workforce and have adequate
recruitment and training strategies in place.

We expect authorities to work with schools
so that they know and build the appropriate

skills for the teaching workforce, and the
DfE is funding scholarships for teachers to

develop their knowledge and skills, including
postgraduate qualifications. Regarding the

question of texting information, this sort
of thing is a local decision. I have told

noble Lords how my local GP practice chose
to sort it, and others may choose to use texts.

On teacher numbers, so far 600 teachers have
achieved or are working towards a qualification

relating to special education needs, and a
further 500 have applied for the current funding

round. I have exhausted the supply of responses
from the Dispatch Box, but I feel absolutely

sure that when we go through Hansard, many
more questions that will come to light, so

we will write a letter to all noble Lords
who have taken part in
the debate.