British Sign Language Users: Access to NHS Services

Wednesday 15th May 2019

(3 years ago)

Westminster Hall
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[Joan Ryan in the Chair]
Joan Ryan Portrait Joan Ryan (in the Chair)
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I draw hon. Members’ attention to the fact that our proceedings are being made accessible to people who are deaf or hearing impaired. The interpreters in the Chamber are using British Sign Language, and the debate will be broadcast on Parliament TV with live subtitles and British Sign Language interpretation.

Catherine McKinnell Portrait Catherine McKinnell (Newcastle upon Tyne North) (Lab)
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I beg to move,

That this House has considered access to NHS services for British Sign Language users.

It is a pleasure to serve under your chairmanship this afternoon, Ms Ryan. I am pleased that we have the BSL interpreters here in the Chamber for the debate and that it will also be covered by simultaneous live BSL interpretation and subtitling on the footage.

I have been trying to secure a debate on this important subject for several months, because for some time now I have been raising the issues with the Government and a number of other organisations. This afternoon’s debate is timely as well, taking place just days after Deaf Awareness Week, which was from 6 to 12 May. As I am sure hon. Members and the Minister are aware, Deaf Awareness Week aims to increase awareness and challenge perceptions of hearing loss and deafness, promote positive aspects of deafness, promote social inclusion and raise awareness of the huge range of organisations throughout the country that support deaf people and their family and friends. That includes the ITV SignPost team, which offers content production, access services and training from their base in Gateshead.

Sadly, given the subject of the debate, there appears to be no reference to Deaf Awareness Week on the websites of the Department of Health and Social Care, NHS England or indeed the Department for Work and Pensions, the Department with overall responsibility for cross-Government disability issues. I am pleased that many local NHS organisations, including the Newcastle Hospitals NHS Foundation Trust, have marked Deaf Awareness Week. The key thrust of my argument, however, is that all public bodies should be aware of and provide for the needs of deaf people, including BSL users, not just one week of the year but 52 weeks of the year. As I will highlight, on far too many occasions that is certainly not happening.

According to the British Deaf Association, the UK has about 151,000 users of British Sign Language, of whom 87,000 are deaf. That first figure does not include professional BSL users, such as interpreters and translators, unless they use it at home. As the BDA has described:

“Sign languages are fully functional and expressive languages; at the same time they differ profoundly from spoken languages. BSL is a visual-gestural language with distinctive grammar using handshapes, facial expressions, gestures and body language to convey meaning.”

Like spoken languages, sign language is not international and is not derived from the spoken language of a country. For example, the UK, Ireland and the US all have entirely separate sign languages, despite speaking the language of English in common.

In 1988, the European Parliament passed a resolution on sign languages, proposing that every member state should recognise its own national sign language as the official language of deaf people in that country, which on 18 March 2003 the British Government did. In 2009, the UK Government went on to ratify the UN convention on the rights of persons with disabilities, which states that Governments must uphold rights by

“Accepting and facilitating the use of sign official interactions…and…Recognising and promoting the use of sign languages.”

BSL, however, still does not have any legal or protected language status, despite many deaf organisations campaigning for that since the early 1980s. Back in 2014, the British Deaf Association published a detailed discussion paper and highlighted the

“policy apathy about the shocking levels of linguistic exclusion we face as individuals and as a community”,


“the shocking extent to which Deaf people are denied their civil rights.”

The paper itself highlighted the good practice that takes place in Finland, New Zealand, Austria and Hungary and set out why our Equality Act 2010 was not working as intended for deaf people—an issue to which I will return. Of course, since that paper was published, the British Sign Language (Scotland) Act 2015 has been passed, requiring the Scottish Government to create a BSL national plan for Scotland to set out their strategy for promoting BSL. That was produced in 2017. The Act also required all other listed bodies such as local authorities to establish their own BSL plans.

I look forward to hearing from the Minister whether her Government have made, or intend to make, any progress towards providing BSL with legal status on a UK-wide level. I recognise, however, that she might have difficulty in doing so, given that it remains somewhat unclear just who has overarching responsibility for promoting and protecting BSL within and across Government.

John Howell Portrait John Howell (Henley) (Con)
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The hon. Lady mentioned the European Union, but another organisation in Europe, the Council of Europe, covers 47 countries. It has already looked at the issue and suggested that countries need to emphasise their BSL equivalents and undertake training to ensure that that is available. Has she seen that report, and does she think it is something that we might like to support?

Catherine McKinnell Portrait Catherine McKinnell
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It is an important report, obviously, but I am interested to hear whether the Government have considered it, what their response is and how that would fit with their overall requirements to better meet our obligations on such issues in this country.

In preparing for this afternoon’s debate, I of course looked back to the 30 November 2017 debate on deafness and hearing loss secured by my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), who is present in the Chamber today. In that debate, the Parliamentary Under-Secretary of State for Health commented:

“It is not entirely clear to me which Department would lead on legal recognition of British Sign Language, which is the problem that so many people have referred to today. I am sympathetic to the calls for strengthening the role of British Sign Language. We want to see as many people trained and providing support as possible. At this time, Her Majesty’s Government are not yet convinced that the way to achieve that is through legislation.”—[Official Report, 30 November 2017; Vol. 632, c. 236WH.]

I therefore look forward to hearing from the Minister whether that position has changed. In the light of some of the issues to which I will refer, I hope it has.

For some time I have been working with a number of local deaf organisations on the significant challenges faced by far too many deaf people in accessing services, information and support. Those organisations include the Newcastle-based charity Becoming Visible, but also Deaflink North East, in particular since I attended a hustings that it organised for the local deaf community ahead of the 2015 general election. At the time, the overwhelming sense of frustration felt by many deaf people about continually having to demand, to challenge, or to fight to access even basic services that most of us take for granted was palpable.

Since then, I have worked to do what I can to make myself accessible to deaf people in Newcastle North as their Member of Parliament, including by launching a BSL section on my website with the support of Deaflink North East, to whom I am extremely grateful. The page includes a subtitled video of a person using BSL to explain, in accessible language, my role as a Member of Parliament, including the types of issues I can help constituents with. Perhaps most importantly, it also makes it clear that should any BSL user from Newcastle North wish to attend one of my surgeries, Parliament can fund a BSL interpreter to facilitate that. In response, the manager of Deaflink, Heidi Jobling, commented:

“We are really pleased that Catherine has taken this positive step towards including the BSL communities. It is so difficult for BSL users to access any type of service and to have our local MP leading the way sends out a clear message, not only to the BSL community but to other providers and organisations, that being accessible is important.”

But this is not about ticking a box and moving on. I hope it is a clear demonstration of my determination to improve accessibility for deaf people wherever I can, including through this debate.

To mark Deaf Awareness Week, the chief executive of the National Deaf Children’s Society wrote a blog entitled “Unsure How to Communicate With Deaf People? Here’s Some Advice”. It revealed the findings of her charity’s recent survey that more than half of British adults do not feel confident talking to deaf people, while one in five has been nervous when speaking to a deaf person, simply because they do not know what to do. The piece opened with a really powerful description:

“Imagine if you were with a group of friends and one of them said something funny, which you didn’t quite catch. Now imagine, while everyone else is laughing, you ask them to repeat it, only to be met with the response ‘Oh, it doesn’t matter.’ What if this happened to you again and again, in lots of different situations? For many deaf people, this is far from hypothetical; it’s real life.”

That scenario is bad enough in social situations, but the constant inability to communicate or be communicated with in one’s own language—and therefore access timely, appropriate and important healthcare, support or information—is particularly serious, as it can be a matter of life or death.

My constituent Ellen O’Sullivan, who is deaf, recently contacted me about the tragic death of a young man from Essex, who ended his life last month. It is reported that, having been assessed as having severe mental health problems and requiring urgent attention, the man was referred to mainstream counselling with the provision of a BSL interpreter, instead of the specialist deaf-focused therapy requested by his GP. Following his death, the specialist counselling service Deaf4Deaf set up a crowdfunding page to establish the Daniel MJ Webster Deaf Mental Health fund, with a target of raising £50,000 to provide six emergency counselling sessions to 278 deaf people with severe mental ill health in the parts of England where the NHS does not fund that. Such support is vital because, as the crowdfunding page highlights:

“The NHS regions who do not offer BSL counsellors use an interpreter with a counsellor. In general hearing counsellors do not understand the specific issues faced by Deaf people.

Interpreted counselling involves a counsellor and interpreter in the room with the Deaf person as they talk about deeply personal issues. Many Deaf people give up after a few sessions because communication becomes difficult.

There is an increasing number of Deaf people asking for NHS funded Deaf focused BSL counselling, they report suicidal thoughts. Many of these people have tried interpreted counselling which was not suitable for them.”

The establishment of this fund in Daniel MJ Webster’s memory is extremely powerful, and it is highly relevant that I raise his case during Mental Health Awareness Week. Does the Minister seriously think it is acceptable that the crowdfunding campaign should have to take place?

On being informed that I had secured this debate, my constituent Ellen O’Sullivan took the trouble to share her wider concerns about access to NHS services for BSL users and to canvass the views of many of her deaf friends. I will share some of their experiences. One commented:

“I am trying to be independent but I am unable to do that because to make an appointment you have to ring up, which obviously I can’t do because I am deaf. So, I have to rely on my mother to ring them or make or cancel the appointment. The doctors do have a website to book an appointment online, but when I need to see a doctor as an emergency on the day, I can’t book an appointment online because the appointments are not available to book until after a week or two.

I do understand that the NHS are trying to save money but as a deaf person I think it is important that doctors and hospitals book an interpreter to be with a patient the whole time while they’re at hospital or the doctors, in case something happens. For example, my partner who is also deaf, had a nose operation. It was a day operation and the hospital only booked an interpreter for 2 hours, but he also needs an interpreter when he wakes up, so he knows what is happening.”

Another explained:

“I am sick of going to the doctor to make an appointment and when they send letters regarding the appointment and the dates I can’t make due to work, I have to get my Mam to ring them and rearrange the time or cancel. I would rather email or text because I hate bothering her to ring up all the time.”

Another of Ellen’s friends commented:

“I don’t want to ask my Mam to make an appointment when I’m 30, I would like to be independent now. We need an app for quick easy access to book GP appointments.”

Another stated:

“I was in hospital for an operation and when I woke up the nurse came up to me and was talking to me, so I told her I was deaf but she was still talking to me! The staff gave me paper and pencil after my operation but I couldn’t write because I was hooked up to drips. I need an interpreter with me all the time!”

Other concerns raised by Ellen and her friends include the use of BSL interpreters who are not fully qualified, and the constant stress and anxiety that deaf people feel before and during medical appointments because they do not know whether their communication needs will be met.

John Howell Portrait John Howell
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The hon. Lady is making an excellent case. I wonder whether she is aware of a number of NHS trusts that have tried to get around the problem, initially at least, by having television screens showing a BSL interpreter who helps the patient to get their appointment. That is a very good start, but it illustrates her point that it is only the start, because the person needs to be there throughout the whole process. Is the hon. Lady aware of that experiment?

Catherine McKinnell Portrait Catherine McKinnell
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The hon. Gentleman raises a point that I was about to make. I said that an app should be available for contacting a doctor’s surgery—I think most doctor’s surgeries would agree. We need to explore the use of technology to make accessing NHS services a reality for deaf people—texts, apps, Skype or FaceTime—and urgently to invest much more in making sure that where there are technological solutions, we harness them to their greatest effect as soon as possible. All NHS staff, whether administrative or medical, need to understand deaf people’s communication needs and NHS buildings must be accessible, with clear plain English signage. Those issues are reflected in the experience of many deaf people in my region.

The Newcastle-based charity Deaflink North East shared the recent outcomes of work that it is undertaking on behalf of Northumbria Healthcare NHS Foundation Trust to identify the issues and barriers that BSL users face, which Deaflink states are common right across the country. They include deaf people regularly being told to telephone to book a BSL interpreter; continually having to remind GPs and hospitals that they need a BSL interpreter and it not being clear whose responsibility it is to book one, despite their communication needs repeatedly being flagged; appointments not being long enough for BSL interpretation; interpreters not having appointments and people being sent home after waiting for a very long time; being asked to sign forms without fully understanding what they mean; being sent large amounts of complex pre and post-operation information, with only telephone numbers provided if they require further advice; staff being generally unaware about deaf people’s communication needs, such as that they need to look up when speaking or should not shout out a deaf person’s name when they are waiting in reception; and deaf people simply not understanding what treatment they are receiving and having no means of finding out, and the likelihood that they are, therefore, being treated without informed consent.

Those communication issues clearly become more frightening in an emergency situation. Last year, deaf blogger Liam O’Dell highlighted concerning findings from freedom of information requests he had made to hospital and ambulance trusts about the BSL interpretation services they provide—or, rather, often do not provide. His article opened:

“Distressed, in pain, in an unfamiliar environment with no means to communicate.

It’s a feeling of isolation one would usually associate with your typical horror movie, but if the right provisions aren’t in place, it can be a real-life nightmare for the 50,000 deaf people in the UK that use British Sign Language as their first language.”

Of course, this issue is by no means restricted to NHS services. The Minister may be aware that, in September last year, I wrote to the Minister for Disabled People after being contacted by Deaflink, which was due to lose its core funding from the Newcastle Gateshead clinical commissioning group in what appears to have been a cost-saving measure. I wrote to the Minister for Disabled People because I felt the wide-ranging concerns Deaflink had raised should be addressed by the Department with overall responsibility for cross-Government disability issues: the Department for Work and Pensions. However, my letter was transferred to the Department of Health and Social Care and then seemingly got lost. I received a response from the Minister in January. That again begs the question of which Department has specific responsibility for promoting BSL and standing up for its users. If the Minister is unable to provide an answer today, I suggest that the Government need urgently to resolve that.

Deaflink’s manager, Heidi Jobling, told me that after more than a decade of working with BSL communities in the north-east, she has seen

“the statutory services available to BSL users getting progressively worse. There are always exceptions, but it is widely acknowledged that, when leaving school, the average reading age of a BSL user is 8-9 years old. The majority of the hearing world do not understand that many BSL users do not feel comfortable or able to communicate in written English. Lip reading is difficult, exhausting and at best about 50% accurate. Yet, these are the fall back communication methods when no interpreter is present.”

She went on to ask how BSL users are supposed to access public health information about things such as joining a gym, stopping smoking, joining a weight loss group, safe amounts of alcohol or preventing diabetes—or, indeed, about how BSL users can access the benefits system, which now is almost entirely online. I dealt with a case in which a leading high street optician did not provide or fund a BSL interpreter for a deaf constituent, believing that offering a double-length appointment and speaking more slowly would be sufficient.

The letter I received from Deaflink highlighted serious concerns about the impact of almost a decade of austerity on BSL users. For example, the adult services sensory team has closed, all BSL-using social workers have been removed, and support to the majority of BSL users has been withdrawn following punitive local authority funding cuts. Heidi Jobling concluded:

“I am writing because I am concerned that, in times of austerity, the needs of the BSL community are the easiest to overlook.”

I find that statement deeply depressing.

I am, of course, acutely aware that the enormous challenges BSL users face in accessing what most people would consider to be everyday services are not restricted to the public sector. Indeed, the Treasury Committee, of which I am a member, highlighted only this week the difficulties that far too many people with accessibility requirements face in engaging with financial institutions and services. That certainly includes BSL users. One of the recommendations we made in our report was that the Equality and Human Rights Commission needs more resources to enforce the Equality Act 2010.

That brings me to my final concern. In response to the concerns I raised on behalf of Deaflink, the Minister emphasised:

“NHS organisations should provide interpretation services to all patients requiring them, including users of BSL Providing communication support to service users is driven by the requirement to comply with relevant legislation, including the Equality Act 2010 and the Human Rights Act 1998, and supporting guidance. This makes it imperative for organisations to provide language and communications support to ensure that patients are able to communicate effectively and appropriately with clinicians and other health service professionals.”

She went on to highlight that

“non-compliant organisations risk complaints and legal challenges, as well as patient safety and other implications.”

Given all the concerns I have highlighted, does the Minister really think the current legislation is sufficient to ensure that BSL users have their communication needs met across the NHS, or will she consider introducing a BSL Act along the lines of the one in Scotland? Given the difficulties that BSL users have in accessing many NHS services in the first place, just how easy does she think it would be for them to make a complaint about those services or to find out anything about the complaints process?

The fact that Deaflink is undertaking the work I mentioned with the Northumbria Healthcare NHS Trust and, to a lesser extent, the Newcastle upon Tyne Hospitals NHS Trust is really positive. Is the Minister confident that all NHS services are taking steps to conduct and then act on similar work, or will she ask NHS England to properly investigate the level of deaf awareness in those services and their accessibility for BSL users? I make a gentle plea to her not to make reference to induction loops or technology for hearing loss. Although those things are extremely important, this debate is about accessibility to NHS services for BSL users specifically.

In conclusion, does the Minister really think it is appropriate to expect adult BSL users to have continually to rely on friends and family—often their parents—to access healthcare and treatment or to discuss private medical information? Is it really acceptable for BSL users to have continually to challenge, demand and fight for access to NHS services that most of us take for granted, or to face delays to their treatment because their communication needs simply have not been recognised and met? That is not a situation that any of us would tolerate, so why on earth should deaf people have to do so in 2019, almost a decade after the Equality Act became law?

Jim Fitzpatrick Portrait Jim Fitzpatrick (Poplar and Limehouse) (Lab)
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It is a pleasure to see you in the Chair, Ms Ryan. I am delighted to follow my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell). I congratulate her on securing this important debate and commend her both for her role as a champion for deaf and hard-of-hearing citizens and for her excellent opening speech. I also thank the House authorities and technicians, and the interpreters—the signers—for their ongoing efforts to ensure that our proceedings are accessible to deaf and hard-of-hearing people. Having spoken recently to senior members of staff, I know that a number of initiatives are being explored, and I look forward to some really positive news very soon.

I am grateful to Action on Hearing Loss for its briefing, and to SignHealth. Action on Hearing Loss offers some top tips for GPs to improve access, such as providing a range of methods for people who are deaf to contact the surgery, providing deaf awareness training for practice staff, and ensuring that people who have hearing loss leave feedback about the quality of their care. It lists troubling statistics about the experience of deaf people at their local health centres. Some 57% of people who are deaf said they felt unclear about their health advice because a sign language interpreter was unavailable for their appointment. Only one in 10 deaf people surveyed had been asked about their communication needs, and two fifths said that staff at their GP surgery still call their name out when it is their turn to be seen. Those numbers indicate a serious lack of attention to deaf people’s needs. You probably know, Ms Ryan, that NHS England has set out an accessible information standard—a clear approach for improving the accessibility of NHS and adult social care services for people with disabilities and sensory loss. Will the Minister comment on how the standard could be better enforced among GP practices in England?

Other recommendations made by Action on Hearing Loss include: introducing loop systems in all GP surgeries; making BSL interpreters available, and allowing for extended appointments when they are needed; and making sure that staff have a good knowledge of the communication needs of people who are deaf or have hearing loss by annotating their medical records and files appropriately.

Action on Hearing Loss quotes from a recent NHS England study, which found that

“deaf people’s health is poorer than that of the general population, with probable under diagnosis and under treatment of chronic conditions putting them at risk of preventable ill health.”

When it comes to mental health, the picture for deaf people is not encouraging. SignHealth reports that deaf people experience significant difficulty in accessing mental health services. Deaf people are twice as likely to experience mental health problems, but their access to help in British Sign Language is extremely poor or non-existent. Deaf people continue to suffer from mental ill health in disproportionate numbers and, sadly, suicide is becoming more of a concern. SignHealth reports that several high-profile deaf men have died by suicide in the past few weeks. Clearly, deaf access to NHS services is a life-or-death issue that needs to be treated with the utmost urgency.

In conclusion, easily solvable problems continue to inhibit deaf people from accessing health care. As my hon. Friend the Member for Newcastle upon Tyne North pointed out, when deaf people want to see their GP, many have to walk to their surgery to make an appointment because there is often no other way for them to do so. When deaf people see their doctor, 80% want to use sign language but only 30% are given the chance to do so. Of the deaf people surveyed, 70% had not been to their GP recently although they had wanted to go, mainly because no interpreter was offered.

On behalf of Action on Hearing Loss and SignHealth, and as chair of the all-party parliamentary group on deafness, I will ask the Minister some questions. It is the first chance I have had to welcome her to her place; I wish her well in all her endeavours. Will the Department for Health and Social Care commit to monitoring performance against the accessible information standard? Will the Department publish performance results? Will the Department commit to providing funding to help with the standards requirements? Finally, will the Minister make representations to the Minister for Disabled People about looking again at the steps that can be taken to improve the market for BSL interpretation?

I am grateful for the opportunity to speak today and to help to represent the views of the deaf community. I hope the Minister can agree to their requests, and that we will start to see a positive change in the physical and mental health of deaf people in England. I look forward to the responses from the Front-Bench spokespeople, especially from the Minister.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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It is a pleasure to follow the hon. Member for Poplar and Limehouse (Jim Fitzpatrick), and I give special thanks to the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for her passionate contribution on behalf of those who use British Sign Language. I commend her for the steps she has taken in her constituency.

I must be honest and say that I do not know much about British Sign Language. The staff in my office are aware of it and we try to have someone available for people to communicate with in BSL, should they wish to; it is important that we as elected representatives provide that opportunity. While I do not have the ability, some of my staff have made it their business to be able to communicate with those who use BSL.

I am happy that my two granddaughters have both learned sign language—in a rudimentary way; not in totality—at school. They can sign their names, which is a small way of moving forward, among other things we can do. I will ask the Minister a question along those lines, but first let me say that I am pleased to see her in her place. She seems to be enjoying her new role, and we are pleased to see her there. The difference between my grandchildren and me highlights the need for young people to have basic skills to enable them to communicate with people who may need their help. It is important that our children have an opportunity to do that at an early stage.

Although we must take steps to address the interpreter system within the NHS, as mentioned by the hon. Members for Poplar and Limehouse and for Newcastle upon Tyne North, I sincerely believe that we also need to make BSL a staple of education, so that every child has a rudimentary understanding of sign language by the time they leave school. I know the Minister is not responsible for education—her role is big enough as it is—but will she communicate with the Department for Education and find out how that can be achieved? It is so important. Our children are often criticised for anti-social behaviour, but I believe our young people are a marvellous example of what the future can hold. Such small steps enable them to have compassion for other people. My boys were always interested in other people, and I am encouraged to know that my grandchildren are the same. If the new generation has an interest in others, that means a whole lot.

The media in Northern Ireland last year highlighted the case of a deaf lady who was going through treatment for cancer, but who did not have an allocated interpreter for any of her appointments. I was shocked by the lack of signers available to NHS trusts in Northern Ireland. An article in the Belfast Telegraph outlined the issue and quoted Ann Owens from the charity Hands that Talk—a lovely name that sums up sign language. She spoke about the lack of signers available for short-notice requests:

“It can be difficult as you can need about two to three weeks’ notice sometimes, but if it’s an emergency there can be times when someone’s not available due to the shortage, including for A&E admissions.”

That is a critical point at which to have interpreters in place. She went on:

“There’s about 25 to 28 British Sign Language interpreters in Northern Ireland and only three Irish Sign Language interpreters, which would mainly be used in the Enniskillen area.”

That illustrates the issue that we want to highlight, and it shows the dearth of interpreters. We need to address that by recruiting more people who can give up their time, and who are paid to be available at short notice. Each trust must have a list of interpreters who can be available at short notice to step into A&E situations. Other Members have referred to this, but it is important to take steps to address the matter where it is at its most critical, which is usually in A&E or on the ward.

I do not want to be critical of nurses—that is not the purpose of this debate—but we need nurses who can communicate in sign language with those who require it. Last year, I was in hospital on three occasions, and I was asked to sign a document to give consent. Truthfully, I was in so much pain that I would have signed away my land and farm; just imagine what it would have been like if I could not understand what I was being told to do, because I was deaf. How difficult would it be for a deaf patient, lying in absolute agony, to be asked to sign something that they did not understand? That shows me how frightening it is for deaf people, and how important it is to have the right people in the right place at the right time.

When foreign nationals go to A&E, interpreters are sourced and money is paid out—rightly so; I support that 100%—and yet our own British deaf people are left out in the cold because of the lack of interpreters. It is not good enough to say that we do not have the signers. We know there is a problem, so let us train staff within the NHS to do the job. The hon. Members for Newcastle upon Tyne North and for Poplar and Limehouse have referred to that, and I think others who speak will do the same. Let us put funding and courses in place to teach signing, to ensure that there is always someone on site who has at least a basic understanding of BSL. It is important to have someone with even a rudimentary knowledge of sign language to communicate. We know there is a problem, we have acknowledged our responsibility and now we must address it.

Although there are 11 million people with hearing loss in the United Kingdom, new research has revealed that a staggering 94% of Brits—I am one of them—know no more than two words of British Sign Language. That really has to change. We have to be more open and more capable of responding, especially in our Government Departments and most especially within the NHS. It is so important to address the issue in the NHS. I look forward to the plan of action to fund and recruit the necessary staff to do what is right for the deaf in our community. I look forward to the contributions of the shadow Ministers from the Scottish National party and the Labour party, but I especially look forward to the Minister’s response. We are very impressed by her so far, and there is no pressure on her.

John McNally Portrait John Mc Nally (Falkirk) (SNP)
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It is always a pleasure to serve under your chairmanship, Ms Ryan. I, too, congratulate the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on securing this debate today following national Deaf Awareness Week. Her initiatives in Newcastle are very worthy; she clearly cares passionately. I add my congratulations to the thought given in having BSL interpreters and signers here today. That was really good thinking. As always, it is a pleasure to follow the hon. Member for Strangford (Jim Shannon) and other Members who have spoken today.

Every day, people with hearing loss get on with work and family life while dealing with all the challenges that that brings. It is difficult to imagine what it is like to cope with a job using public transport, as well as coping with shopping and meeting your child’s teacher, when basic communication, which the rest of us take for granted, does not come easily. Almost 9 million citizens in the UK, including 50,000 children and 758,000 people in Scotland, have some degree of hearing loss, as have I. At least 24,000 use British Sign Language as their main form of communication. They are a large and important part of our community, and they need us to be more aware.

Access to NHS services is an important improvement that we can make to the lives of those in our deaf community. To support people who use British Sign Language, as mentioned earlier, NHS Scotland has created information in BSL for a range of health topics, including accessing NHS services in Scotland.

Scotland was the first country in the UK to legislate for BSL to achieve legal status. The British Sign Language (Scotland) Act 2015, passed unanimously by the Scottish Parliament, promotes the use of British Sign Language and made provision for the preparation and publication of the British Sign Language national plan for Scotland, which we now have. The BSL national plan sets out 70 actions that Ministers will take to improve the lives of people who use sign language, backed by £1.3 million of public funding.

Under the plan, BSL users will have access to the information and services that they need to live active, healthy lives and to make informed choices at every stage of their lives. The national plan’s health, mental health and wellbeing actions include, among other things, publishing a schedule for making all screening and immunisation information accessible in BSL; increasing the availability of accurate and relevant health and social care information in BSL; developing a learning resource for health and social care staff to raise awareness of sign language and deaf culture; and working with partners to deliver and evaluate two training programmes aimed at supporting BSL English interpreters to work within the health sector, with a view to informing a longer-term approach.

NHS Greater Glasgow and Clyde has appointed a health improvement practitioner to support mental health in the deaf community, which will help raise mental health awareness and empower that community, allowing them better access to services. In the wider community within my own Falkirk constituency, I have surgeries every month at a wonderful place called the Forth Valley Sensory Centre, which is run by volunteers. I can recommend its coffee and square sausage. People with hearing loss are welcome to come along. Everyone is welcome, by the way, if they like square sausage.

Catherine McKinnell Portrait Catherine McKinnell
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The Minister is not familiar with the concept of square sausage.

John McNally Portrait John Mc Nally
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Many people are not familiar with the concept of square sausage. I tried to introduce it some time ago when I first came down here; it was refused by the catering staff, but I shall redouble my efforts.

The centre is a place where people with hearing loss or visual difficulties can access quality services, advice and equipment that helps them to be as independent as possible. Practical support is there for the deaf community at all stages in their lives. In fact, my mother-in-law, Mrs Chalmers, and my own mother, Rosa, made use of the services in the not-too-distant past. Young people looking for work can access advice on job seeking and training. It is also a thriving social hub, holding a range activities and giving folk a chance to chat, try new skills and have fun. It was the first of its kind in the UK and has proven to be an absolutely invaluable resource to the community.

As with all language skills, it is good to teach communication to the young. We see successful examples in some children's television programmes, using a system of signs and symbols called Makaton. It is picked up by all young viewers, not just the deaf community. The more who know some of the skills, the better. It helps us talk to each other at the earliest stages.

I want to draw attention to the inspiring “I’d like to teach the world to sign”, an initiative known as Hands of the World, co-ordinated by the remarkable Sharon Tonner-Saunders of the University of Dundee. She brings music and sign language together across the globe. Some 40 countries are participating. It is a great example of horizontal communication integration, and I ask everyone to Google it and have a look.

The Scottish Government have a plan for primary schools called the 1+2 language plan, which requires every child of primary school age to have experience of their native language, whatever it may be, and of two additional languages—they could be French, Mandarin or British Sign Language. The Scottish Qualifications Authority qualification in BSL is being developed and SCQF levels 5 and 6 will be available from autumn 2019. The UK Government have not yet committed to introducing a GCSE BSL qualification. Rather, they will consider introducing one before 2022, but we hope that action will be taken sooner.

We want to make Scotland the best place in the world for BSL users to live, work and visit. A start has been made, but the efforts must continue. I hope the same thing happens here in Westminster, so let us keep talking—and, of course, signing.

Julie Cooper Portrait Julie Cooper (Burnley) (Lab)
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Thank you, Ms Ryan, for your chairmanship of today’s important debate on an essential issue for our times. I thank my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for securing this debate and for her passionate speech and obvious commitment to acting on behalf of her own constituents and deaf people everywhere. She has inspired me to audit the provision in my constituency to see what I can do to make things easier for the deaf. I want to say how pleased I am to see Parliament facilitating sign language and subtitles here today. I spoke to the Minister ahead of the debate and we agreed that it would be wonderful if such provision could be made available in every debate in this place.

Jim Fitzpatrick Portrait Jim Fitzpatrick
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I alluded to the fact that a lot of progress has been made behind the scenes. The authorities are working very hard to see whether provision can be made, as it is in other Parliaments around the world. The Independent Parliamentary Standards Authority gives financial support for tuition for MPs who want to learn BSL, so perhaps we can make colleagues more aware that that facility is available also.

Julie Cooper Portrait Julie Cooper
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That information is helpful. I am sure that a number of Members would like to take advantage of that and learn more, and perhaps make a commitment to becoming signers.

As my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) reminded us, two thirds of people with hearing loss have left their GP surgery feeling unclear about the health advice that has been provided. The scale of the problem is that there are 11 million people living with hearing loss. That is one in six of the population. The charity Action on Hearing Loss estimates that by 2035 15.6 million people will have some sort of impairment. It is time we took that seriously and focused our attention on solutions. It beggars belief that 40% of deaf people say that staff at their medical healthcare provider have called out their name to announce that it was their turn to be seen by a healthcare professional. It is hard to believe, but it happens all the time.

We have also heard about difficulty in making telephone applications. The Secretary of State is focusing on technology, and perhaps he might want to look at the request for an app to make emergency appointments for a deaf person. The Minister could advise him about it. Other issues include the fact that in trying to communicate on the telephone there is obviously no one to sign, and no opportunity to lip read. There can sometimes be difficulties with reading documents, because often when someone’s first language is sign language they fall behind with their reading level, which adds to the difficulties.

Those communication barriers mean that many people rely on friends and family members when navigating NHS services. We have heard about the challenges that someone experiencing hearing loss or deafness has in dealing with life in general, but none can be more important than those arising over health matters. When deaf people are forced to rely on family members, their independence is clearly compromised. Their confidence is undermined and their right to confidentiality is taken away. It is estimated that communication difficulties experienced by people with hearing loss cost the NHS an extra £76 million a year in additional, unnecessary GP visits. Those barriers may also deter some patients from seeking medical advice and attention, which could lead to their having more serious conditions and more expensive treatments—so the situation is not cost-effective, either.

Last year there was a BBC broadcast showing some distressing experiences of deaf people who were undergoing complex medical treatments for serious conditions, with no one to explain properly what was happening. The reporter concluded that deaf people were being left behind by the NHS and described a moving scene in which a patient undergoing complex investigations in connection with cancer treatment was absolutely terrified. There was no one there for them to talk to, although they felt extremely unwell and totally frightened. The hon. Member for Strangford (Jim Shannon) touched on that very point, which is a powerful one, about empathising—putting ourselves in the place of a deaf person and thinking what it might be like for them, given that such procedures can be frightening even when we are able to ask “What is that for?”, “How long will this go on?” and “What happens next?”

The issue could easily be addressed by the provision of trained interpreters with a full working knowledge of British Sign Language. BSL is a visual-gestural language that is the first or preferred language of many deaf people and has its own grammar and principles, which differ from English. The provision of British Sign Language interpreters would surely facilitate a kinder, more efficient, more cost-effective service. Members have mentioned that where such a service is provided it is done in a limited fashion. Someone who is in for five hours of medical treatment will be given an interpreter for only two; or the interpreter will not be there when they awaken after an anaesthetic. Clearly that is not good enough. My hon. Friend the Member for Poplar and Limehouse talked about the mental health issues that deaf people face disproportionately. Is it any wonder, given the isolation forced on them?

The whole issue relies on the recognition that for many deaf people sign language is their first language. English is often their second language, so providing a British Sign Language interpreter is as important as providing an interpreter for a speaker of a foreign language. Surely the Government must recognise that access to a BSL interpreter should be not an optional extra but a fundamental right. More than that, not only is the lack of qualified British Sign Language interpreters discriminatory; it is putting the health and, in some cases, the lives of deaf people at risk.

Those who suffer with deafness or hearing impairment have a legal right to support. Since August 2016 all organisations that provide NHS care and/or publicly funded adult social care have been legally required to follow the accessible information standard. The standard sets out a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients with a disability, impairment or sensory loss. In addition, the Equality Act 2010—landmark legislation introduced by the last Labour Government—made provision for equality in all public services and made a specific demand for service providers to make reasonable adjustment to avoid substantial disadvantage. Offering the services of an interpreter is cited as an example. The failure to provide support and British Sign Language interpreters is not just undesirable: it is a breach of the law.

We understand that the Minister who is responding to the debate cannot tackle all the issues on her own, but if she has been as moved as the rest of us by some of the speeches we have heard, we ask her to offer a lead. We want her to liaise with her colleagues in the Department for Education and the Department for Work and Pensions, and to talk to the Minister for Disabled People, Health and Work about taking the issue forward to ensure that the communication needs of all those who are deaf or who have some hearing loss are assessed and that, where necessary, a qualified BSL interpreter is always available.

Will the Minister demonstrate today that she understands the problem, which amounts to discrimination on the basis of disability? Will she listen, as I did, to the examples of good practice from Scotland, Finland, New Zealand and Hungary? If they can get it right, I am sure it is not beyond us to take some action.

Seema Kennedy Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)
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It is a pleasure to serve under your chairmanship, Ms Ryan. I will begin with the observation that I was wondering how to include square sausage in my speech. I do not think it will fit in anywhere, but I am very much looking forward to speaking to the hon. Member for Falkirk (John Mc Nally) and finding out more.

I thank the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for securing the time for this important debate. I know that she has wanted to raise the matter for some time. As last week was Deaf Awareness Week, the debate could not be more timely. What a pleasure it is that we have two interpreters here today; we welcome them. I know that Mr Speaker is committed to making Parliament accessible to all. It was great to see that one of the senior Clerks was present just now. Let us hope that she takes what was happening back to the Speaker. I am sure that the shadow Minister, the hon. Member for Burnley (Julie Cooper), and I can speak to the House authorities about the possibility of a pilot in Westminster Hall. We have discussed whether we might ask even a team of interpreters to interpret busy sittings in the main Chamber—I do not think that some interventions deserve interpretation anyway, but this is an important issue, and it is wonderful that we have subtitling and interpreters here today.

Ensuring fair and equitable access to public services, including but not limited to the NHS, is of critical importance to disabled people. I thank the hon. Member for Newcastle upon Tyne North for all the efforts that she has made in her constituency to use BSL to be more accessible to her constituents. I will definitely reflect on that with my team. I also want to thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for his careful stewardship of the all-party parliamentary group on deafness, and for the group’s work. It has done a lot of work to raise awareness and improve the way that we support people with hearing loss or deafness.

I shall attempt to answer several points raised by hon. Members, but I hope they will bear with me if I do not answer them all, in which case I will write to them. I am afraid there was nothing on the Department’s website about Deaf Awareness Week, but if I am still in post next year, I and the Minister for Care, who was due to respond to this debate, will ensure that that is no longer the case. NHS England highlighted Deaf Awareness Week on social media, including advice on how the NHS can help the one in six people who are estimated to have hearing loss. On Twitter, the NHS Business Services Authority published a video highlighting how its technology team have been learning BSL to support deaf colleagues.

The Government consider that current legislation is sufficient—I will speak more about that issue—but the challenges raised by hon. Members today mean that I will look carefully at what more we can do to communicate obligations under existing legislation to individual NHS trusts. The issue of BSL as a language is probably a matter for the Department for Digital, Culture, Media and Sport rather than the Department of Health and Social Care, but all Departments have a responsibility to create inclusive communities. I will take away the comments made by hon. Members and discuss them with ministerial colleagues in other Departments.

The hon. Member for Newcastle upon Tyne North brought up a distressing example of the gentleman in Essex, and mentioned issues of deafness and mental health—of course, we are thinking about mental health this week. The Government are committed to that issue, and addressing mental health is at the heart of the long-term plan. We are investing £2 billion over five years to improve mental health services, and NHS England commissioned specialist mental health services for deaf people, including in-patient and outreach services. The hon. Lady and the shadow Minister asked me to ask NHS England to look at health services for deaf people, and I am happy to raise those points and look at what the Care Quality Commission is doing. The hon. Member for Poplar and Limehouse set me several challenges, and I will attempt to address the performance results later in my remarks. If I do not, I will be happy to talk to him after this debate or hold a meeting, and I would also be happy to speak to the Minister for Disabled People.

I was asked how we can help more people to know about British Sign Language—indeed, the hon. Gentleman mentioned that his grandchildren are learning it at school. The Department for Education has confirmed that it will begin working with experts to develop subject content for a British Sign Language GCSE, and that will be assessed against the rigorous subject content criteria that apply to all GCSEs. Ofqual will also need to consider the proposal against its assessment criteria. Schools have asked for a period of stability to provide them with a chance to embed the extensive reforms to GCSEs and A-levels, and in March last year, the Education Secretary confirmed that the Government will not introduce further reforms to GCSEs or A-levels beyond those committed to during this Parliament. However, if a British Sign Language GCSE can be developed in line with GCSE requirements, the Government will consider making an exception to their rule on stability, and introducing it this Parliament, and I hope hon. Members will be encouraged by that.

As hon. Members have said, British Sign Language is the primary form of communication for many deaf people and fundamental to the way that they communicate with their families and loved ones. I thank everybody—interpreters, teachers and users of BSL—for their work, which helps people with hearing impairments to lead fulfilling lives in our communities. About 24,000 people in the country have BSL as their first language, and it is essential that they can communicate with NHS staff and services to access the best possible healthcare.

This Government are committed to a truly world-class health service that must be equally available to all. People must be able to communicate their needs and access the information, advice and support that they need to complement the hands-on work of health professionals. Some people may need additional support or to be supported in a different way. We must take proactive steps to provide support for reasonable adjustments —hon. Members highlighted examples of where that is perhaps not happening, and I will take note of that.

Let me focus on the robust framework that we have in place to ensure that reasonable adjustments are made to permit access to NHS services for those with hearing impairments and those who use BSL. Existing equality legislation means that employers, service providers and public bodies must provide services in BSL when it is reasonable for them to do so. That was underpinned by the Equality Act 2010, which places a duty on all public bodies to make reasonable adjustments so that disabled people are not put at a disadvantage compared with those who live without a disability. Commissioners of NHS services must pay due regard to the needs of their population, including those living with a disability, when planning and commissioning services.

Service providers must consider what disabled people who use their services might need and make reasonable adjustments accordingly. That includes, where appropriate, access to BSL services. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 further expand on how the NHS should implement the Equality Act and make reasonable adjustments. Such provisions help to ensure that people are treated at all times with the dignity and respect that they deserve. A key part of that is the accessible information standard, which is essential for an effective high-quality health service. It was introduced in 2015 and clarifies what health and care services must do under the Equality Act to make reasonable adjustments so that people with additional communication needs are not put at a disadvantage.

All organisations that provide NHS care or publicly funded adult social care are required to comply with the accessible information standard, which sets out how patients and service users—including carers, where appropriate—should receive information in a way that is accessible to them. The Care Quality Commission, which monitors how the standard is put into place, specifically highlights that that includes users of British Sign Language. One wonderful example of that is the fact that BSL users can use the NHS 111 BSL language service, which provides telephone advice on when to seek further medical help, advises on medication use and provides tips on self-care. BSL users can download an app that enables them to connect to an interpreter via a webcam, and the interpreter then relays the conversation to the 111 adviser. Such technology is a great passion of the Secretary of State, and I will take away the comments that have been raised about that during the debate.

For standards and duties to be effective, compliance must be monitored and action taken where needed. When it inspects a service, the CQC uses five steps to identify whether it is complying with the accessible information standard to ensure that people with disabilities can access health and care services. Those five steps focus on how services identify and assess needs and how they are planned, how services clearly record identified needs, what steps are in place as part of the assessment and care planning service, and how services flag information and communication needs and their records, given that the method used must make it possible for all staff to be quickly made aware of and work to meet those needs. Finally, the CQC assesses whether services meet an individual’s needs, ensuring that people receive information in a way that they understand. That might mean arranging communication support if people need it, and it could include access to a BSL interpreter or lip reader, or using a hearing aid.

Organisations are required to publish an accessible communications policy and establish a complaints process. It is important that organisations support users to provide feedback and help to improve those services. In 2017, NHS England led a post-implementation review of the accessible information standard, which provided an invaluable opportunity to assess its impact and ensure that it remains fit for purpose. Following the review, a revised specification was issued. Although there were no substantive amendments, there were changes to the definition of some terms, and clarification of requirements regarding the Mental Capacity Act 2005 and data sharing. The review showed that there was widespread support for the aims of the standard and that patients and carers were clear that receiving accessible information is essential if they are to receive high-quality, safe care.

More generally, there is an action plan on hearing loss, which sets out key objectives including prevention, early diagnosis, maximising independence—a point the hon. Member for Newcastle upon Tyne North made—and enabling people to take part in everyday activities, such as gaining access to work. There is already a commissioning framework published as part of the action plan, and a joint strategic needs assessment for local authorities and NHS commissioners is expected this summer.

The National Institute for Health and Care Excellence published “Hearing loss in adults: assessment and management” in June 2018, which will form the basis of developing a quality standard for adult onset hearing loss that clinical commissioning groups can use to support commissioning. The action plan on hearing loss consortium is led by NHS England, which works with stakeholders across a system to tackle this important issue and galvanise action, given the rising prevalence of hearing loss.

Jim Fitzpatrick Portrait Jim Fitzpatrick
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I commend the framework document and the action plan published last year; the Department of Health got a lot of plaudits for putting in place a plan to ensure that that which everyone has been raising is delivered on the ground. I would be very grateful for reports on how well the Department is doing, on cross-government support, and on progress in the NHS, because what is on paper is very good and got huge support from the deaf and hard-of-hearing community last year.

Seema Kennedy Portrait Seema Kennedy
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I thank the hon. Gentleman for his comments. Once plans are put in place, it is important that we monitor them, assess them and review them. I am happy to ensure that the Department keeps lines of communication open with the hon. Gentleman and his group on this matter.

I hope that I have provided some reassurance that there is a robust legislative framework, standards that enact it and a monitoring regime in place. This debate has highlighted where we can sponsor greater responsiveness—I appreciate the important point that the hon. Gentleman in particular made about the market for interpreters. I take these concerns very seriously and I am committed to communicating with colleagues across Government. I will finish by thanking the hon. Member for Newcastle upon Tyne North for highlighting such an important issue.

Catherine McKinnell Portrait Catherine McKinnell
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I must begin by apologising for the fact that, in my enthusiasm to set out this debate at the beginning, I did not welcome the Minister to her new post or acknowledge that she has stepped in to this debate at short notice. It is often the way in Parliament, when two issues come up in two different places at the same time. I thank her for her response today.

I also thank everyone who has contributed to the debate, which has been incredibly constructive. It has highlighted that there is some good practice, but still an awful lot of work to do. I know that much of that work is taking place within the all-party parliamentary group, and I commend my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on the tireless work that he and his group do on this matter.

I thank the hon. Member for Strangford (Jim Shannon) for his positive contribution to the debate and the SNP Front-Bench spokesperson, who managed to get a reference to Lorne sausage into his remarkable contribution. I studied in Edinburgh, so I am very familiar with the square sausage concept.

In all seriousness, while the Minister has given some positive feedback, there is still a question about who in Government is responsible for this matter. Who is the champion within Government? Who will take this on? I have no doubt about the Minister’s sincerity in taking on the points raised in this debate, but it would be good to know who has responsibility in Government for delivering on this, and I would be grateful if we could get a clear answer to that from the Government in response to this debate.

I must also raise a concern with one of the statistics that the Minister used in her response. She referred to there being 24,000 people who have British Sign Language as their first language. That is a disputed figure because it comes from the 2011 census, in which British Sign Language users were not able to properly participate, due to their inability to access the census in the way that those not having British Sign Language as their first language were able to. Their figures for users of British Sign Language are that 50,000 people have it as their first language and that 87,000 people in total use it. I just put that on the record, because it affects a large number of people, not to mention their families and friends and those around them.

As we were talking, I was reminded of another experience that somebody told me about, which has driven a lot of my passion in this area. It was quite a disturbing story: a gentleman went to the hospital with his father as the interpreter for a medical consultation to get the results of some tests. When they received a diagnosis of cancer, the son was so upset by the news that he left the consultation room, because he could not interpret it for his father. That to me is unforgivable. It is not how our NHS services should be. I therefore implore the Minister to do everything she can to champion this issue, both in the Department of Health and Social Care and across Government.

Question put and agreed to.


That this House has considered access to NHS services for British Sign Language users.

Sitting suspended.