British Sign Language Users: Access to NHS Services

Jim Fitzpatrick Excerpts

Wednesday 15th May 2019 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

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.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

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]

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]

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.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

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]

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]

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.