Mental Health Services: Sign Language Users
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I thank the noble Lord, Lord Ponsonby, for securing this short debate on the mental health of deaf people who use British Sign Language. Over 10 million adults in England live with some degree of hearing loss and, while some will be among the one in 700 babies born with hearing loss, many of us will develop hearing loss over our lifetime. With an ageing population, this figure is only going to increase, with the World Health Organization predicting that by 2030 there will be an estimated 14.5 million people in the UK with hearing loss, with adult-onset hearing loss predicted to be among the UK’s top 10 disease burdens.
We know from research that deaf people are at a much higher risk of mental ill health than the general population, with 40% of the hearing-impaired population and 50% of the profoundly deaf expected to experience mental health problems during a lifetime, compared with around 25% within the general population. It is therefore vital that we provide deaf people with appropriate services that support their mental health needs.
The Government are committed to improving mental health services and ensuring that those services have equal priority with those for physical health. Our mandate to NHS England makes it clear that everyone—I emphasise “everyone”—who needs them should have timely access to evidence-based services. Over £400 million is being invested over the spending review period to make a choice of psychological therapies available for all those who need them in all parts of England. We have put in place for the very first time waiting-time standards for mental health, a significant milestone on the road to parity.
The NHS is a universal service. I listened with care to the remarks from the noble Lord, Lord Hunt, about equality. NHS England is under a specific legal requirement in relation to tackling health inequalities and advancing equality. The Government will hold NHS England to account for how well it discharges this duty. We recognise the importance of deaf people being supported and enabled to communicate through British Sign Language where they wish to do so. Section 20 of the Equality Act 2010 requires CCGs to make “reasonable adjustments” so that disabled people are not placed at a substantial disadvantage compared with non-disabled people. The reasonable adjustment duty is an anticipatory duty, meaning that service providers are expected to anticipate the requirements of disabled people, and the reasonable adjustments that may have to be made for them, before any disabled person attempts to access the service in question. Simply put, it is not acceptable for health services not to be equipped to provide communication support to those who need it.
Equality legislation means that service providers and public bodies must provide a reasonable adjustment to their services to meet the needs of clients when it is reasonable to do so. This may be the provision of interpreters or services delivered in BSL. In September 2013 the Prescribed Specialised Services Advisory Group, PSSAG, considered a proposal from SignHealth for NHS England to commission psychological therapies for deaf sign language users. The PSSAG felt that although the provision of IAPT services using BSL was clearly complex, it did not meet the requirements for a specialised service commissioned directly by NHS England, and therefore responsibility for commissioning psychological therapies for deaf sign language users should remain with clinical commissioning groups. The PSSAG recommended that CCGs be signposted to the relevant organisations and informed about the services and support that they can provide to deaf patients.
From his remarks, the noble Lord, Lord Ponsonby, was clearly in favour of community and secondary deaf mental health services being commissioned as a specialised service. I am sure he will understand that any proposal of that kind would need to be considered by the PSSAG. However, with regard to NHS England retaining responsibility for existing specialised deaf mental health services, even if co-commissioning were introduced I can assure him that NHS England will retain the responsibility as set out in the mandate and the Manual for Prescribed Specialist Services for the specialised deaf services. Future collaborative commissioning arrangements have not been confirmed as yet, but that will not alter NHS England’s responsibilities as the responsible commissioner. However, we know that more needs to be done.
As the noble Lord, Lord Ponsonby, mentioned, my right honourable friend the Minister for Care Services, Norman Lamb, recently met SignHealth. At this point, I pay tribute to the exceptional work of SignHealth in promoting the same sort of access to healthcare and health information for deaf people as hearing people receive. I have visited SignHealth on more than one occasion. SignHealth impressed upon my right honourable friend the importance of psychological therapies for deaf people through the Improving Access to Psychological Therapies service. Since the meeting, officials have been working to develop proposals in support of the commissioning and provision of psychological therapies for deaf people in England. The noble Lord, Lord Ponsonby, asked whether a working group could be established to look at this issue further. I believe that is a sensible suggestion, and I am happy to commit to it. In the mean time, we will remind clinical commissioning groups of the importance of commissioning IAPT services that are accessible to British Sign Language users.
We are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We have made considerable improvements over recent years, including the rollout of a national screening programme for newborn children, significantly reducing waiting times for assessment and treatment and greater choice of hearing aid services—for example, through independent high-street providers.
NHS England is developing a new accessible information standard which will provide clear guidance to health and social care organisations on the steps they need to take to ensure that disabled patients, carers and service users receive information in appropriate formats, and communication support if they need it. This will include the provision of interpreters or BSL users for deaf people. NHS England has worked closely with SignHealth in the development of the standard, and SignHealth has offered advice about aspects of the standard which relate to deaf people. It is anticipated that the standard will be published in the spring and that organisations would then have 12 months to implement it. Alongside the statutory information standard, NHS England will publish guidance on making reasonable adjustments to meet the communication needs of service users with disabilities.
As well as an information standard, NHS England, alongside the Department of Health, is developing an action plan on hearing loss which will identify the key actions that will make a real difference to improve the lives of all those with hearing loss. The action plan is in its final stages of development with a view to being published soon. I hope that goes some way to address the question asked by the noble Lord, Lord Hunt, about a national service framework or the equivalent thereof.
I shall, of course, write to noble Lords whose questions I am unable to answer in the debate. My noble friend Lady Tyler asked me several questions. One was about the 2005 document Mental Health and Deafness—Towards Equity and Access. There are no plans to update that document. She also asked me, as did my noble friend Lord Borwick, about what we are doing to support CCGs to increase the data collected in their local communities to help inform mental health commissioning for deaf people. Our goal is to create the most open and transparent healthcare system in the world. To support this ambition, we need to build a truer, more up-to-date picture of mental health and well-being, both nationally and in each area. The current level of information collected on IAPT represents the gold standard of data collection. We have robust information on the numbers of people accessing services, how long they wait, how many recover or improve as a result of treatment and the cost of these services, which is a genuine world first in mental health. Our ambition is to bring the same standard of information to all mental health services over time.
My noble friend and the noble Baroness, Lady Hollins, asked about the supply of medically skilled interpreter services. It is clear that we need to work across government and with the voluntary and public sectors to encourage more people to come forward to train and qualify as BSL interpreters. We know that it takes at least three to five years to train a person in BSL to level 3, which is a basic requirement for a therapist/clinician. NHS England advises us that this will be addressed within a framework for workforce planning.
My noble friend Lord Borwick spoke with tremendous authority about the mental health needs of deaf children. Children and young people’s mental health is a key priority for the Government, as I hope he knows. In August 2014, we launched the children and young people’s mental health and well-being task force. That task force brings together a range of experts. It is looking at how to improve the way children and young people’s mental health services are organised, commissioned and provided and at how to make it easier for young people to access help and support, including in schools, through voluntary organisations and online. That very definitely includes deaf children with mental health problems.
My noble friend Lord Addington spoke very powerfully about the use of technology. As he will understand, this is a decision for individual providers, but the NHS’s ambition is to embrace technology as part of its drive to offer modern, convenient and responsive services to patients, their families and their carers. General practices are leading the way on that. The NHS is working with local commissioners and is undertaking a number of pilots to redefine and improve the design of the future NHS 111 service, which includes improvements to the text relay service, making it easier for text relay users to navigate to a service provider. As regards the delivery of psychological therapies to deaf people, we are currently exploring the commissioning of online BSL or text-based models of delivery.
The noble Lord, Lord Hunt, asked me about the UCLH project. University College, London, has developed a case with the Deafness Cognition and Language Research Centre on what a deaf cognitive service should look like. We understand that proposals for the future of the services are under discussion.
I hope that in the time available I have been able to reassure the noble Lord, Lord Ponsonby, and indeed the House, of this Government’s continued commitment to meeting the specific needs of deaf people and that we take this issue very seriously.