Lord Addington
Main Page: Lord Addington (Liberal Democrat - Excepted Hereditary)
Lord Addington (LD)
My Lords, having seen the title of the SignHealth report, I was surprised by nothing that I read in it. If you think about it, when you are dealing with a medical situation, being able to tell somebody what the matter is has to be a huge advantage. Man as an animal is supposed to be a compulsive communicator. One major thing that we do is to talk to each other and if something gets in the way of being able to communicate properly, we will have problems. The question is: how do we deal with that? We will never get it absolutely right.
I have to declare an interest. I am chairman of a company called Microlink, which supports disabled people through its innovations, usually involving computing. This has led me to take a closer look at this area. Indeed, one of our case studies concerned being an online interpreter. Most of us are online. It is a much better use of an interpreter’s time to be able to use British Sign Language online than it is for him or her to have to follow a person around.
In addition, if we are supposed to be enhancing the dignity of a person, we want to give them as much independence as possible. A translator is an expensive, difficult piece of kit you may not want in the room when you are talking to your doctor about, for example, sexual health or reproduction, particularly if they are there all the time. Having something online, as described here, seems a perfectly sensible way forward but to use it both parties must know that it is possible and how to access it. Making sure that that information is discerned throughout the system for the client base and the provider is essential to getting the best out of it. That must be looked at and people must know it is available. If it can be done comparatively easily, which seems to be the case, everyone must know. That would enhance the dignity of the patient and make the job of the doctor easier. We can go into the night speaking about that.
As the noble Lord, Lord Borwick, has mentioned, lots of technologies are language-based. If you are literate, you would have another means of communication. As someone who is dyslexic, I have a little story about one of these bits of technology. Through the aforementioned interest, I saw a wonderful piece of kit which addresses literacy and gives a person some personal space. The UbiDuo comes from the States, although I do not think that we would have given it that name. Basically, you use two keyboards and two screens that are roughly the size of small computers, and you get instant translation of your communication to someone else. They can read it and communicate back. I was shown this at a conference where everyone else was oohing and ahing about it. I discovered that I was the only person who could not use it because I am dyslexic, which shows that everything has its limitations. However, if you are informed and know what is going on, you can overcome that and get through to the other person. A line of communication can be established. There are many different types and uses of language. If we can establish the fact that they are available and known about, these problems will be cut.
Most of what we are talking about will cut across government departments. How would anything being talked about here not be covered in one’s health employment profile? I bumped into Mike Penning, the Disability Minister, who said that he is going to try to work across departments. It is nice to know that disability has been slightly pushed up and now has a Minister of State. There will be the same problems in health, employment and education. Everything relates and cross-references. How we deal with that is very important.
When someone leaves a medical establishment, hospital or doctor’s surgery, how will they interpret the lifestyle support that they will receive? I know Mike Penning reasonably well and he is a tenacious individual but I do not know how much he and Ministers in other departments can make sure that this support is followed through. If deaf people are overweight and want healthier lifestyles, it is true that they have more trouble accessing, for example, exercise and outdoor activity. What are we doing to make sure that they can or that they do not have to jump over hurdles? We should be able to take our solution from one place to another.
We have just heard a very positive description of what might happen with cochlear implants. That will never deal with all the problems but it might deal with quite a lot of them. However, as the noble Lord said, most people’s hearing problems are probably late onset. As with most disabilities, they build up. The deaf community has vociferous factions within it which will tell you that true deafness is something else, that it is what they have and not what someone else has, and that their approach and nothing else is the proper one. They are like all other communities I have ever met in that regard. However, unless you can get an approach which covers a variety of ways of dealing with the communication problem, addresses all those areas and accepts that they are all equally valid, you will always create more holes, cracks and barriers than you should otherwise have.
Finally, I have a story about the aforementioned UbiDuo. When Esther McVey was the Minister for Disabled People, she was at a conference and decided to have a chat with the deaf man who was doing a demonstration. After a long conversation with aides possibly tugging at her elbow to get her out of the room, we went along and said, “This is wonderful. Isn’t it a great piece of kit?”. A woman from the next stall said, “I wonder if she would have been quite so keen if it wasn’t such a tall, good-looking man on the other side”. If my honourable friend had not noticed that, the woman on the next stall certainly had. Allowing someone to interact on a basic human level is what we are after. This is merely an application that can be used in the healthcare that we are looking at. Unless we approach it like that, we will miss far more opportunities to enhance people’s lives overall than we should.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to my noble friend Lord Ponsonby for his initiative and his excellent speech. I declare my interest as chair of an NHS foundation trust, a consultant and trainer with Cumberlege Connections and president of GS1.
Parliamentary debates about the quality of public services to deaf people are all too infrequent. Therefore, like the noble Baroness, Lady Howe, I welcome the opportunity to put that right tonight. As noble Lords have said, it is particularly opportune because of the publication on 25 March of this excellent report by the deaf health charity SignHealth. I was very privileged to speak at the conference held on 25 March to launch the report.
As my noble friend said, the report makes very sobering reading. He went through some of the details, but the headline results of issues in relation to deaf people in the health service—underdiagnosis, poorer treatment, poorer communication and lack of accessible health information—are a salutary wake-up call to us all. As the noble Baroness, Lady Howe, said, this has been reinforced by some interesting work by local Healthwatches, which we were sent over the weekend. The noble Baroness referred to Kirklees Healthwatch, but I also notice work in York, Wakefield, Staffordshire, Enfield, Islington and Stockport. All of those local Healthwatches are doing good work in their areas. I hope that the Government will listen to what Healthwatch is saying and act on some of its recommendations and proposals.
My noble friend referred to a number of recommendations made by SignHealth to try to turn the situation around, such as communications agreements for each deaf person coming into contact with the health service. It is surely a sensible recommendation that they should be able to book appointments online using SMS text to communicate with services. Also, health information needs to be more accessible in other formats, including British Sign Language and subtitles. Importantly, there is the recommendation on psychological therapies, which ought to be available to deaf people in British Sign Language nationwide. It has been reported to us that Ministers have turned that recommendation down. I would be grateful if the Minister could update the House on that. If Ministers have turned it down, does she think that that is consistent with the Equality Act duty?
I want to ask the Minister about this more generally. She knows that individual National Health Service bodies and the department’s arm’s-length bodies have public sector equality duties under Section 149 of the Equality Act 2010. This duty requires public authorities to have due regard to eliminate discrimination between those with and without a protected characteristic and to advance equality of opportunity between those with and without a protected characteristic. My understanding is that that means removing or minimising disadvantages suffered by people in protected groups and considering steps to meet the needs of protected groups where they are different from those of other people. Public authorities are also under a duty to make reasonable adjustments for disabled people to make sure that a disabled person can use a service as close as reasonably possible to the standard usually offered to non-disabled people. From the SignHealth work, it is pretty apparent that for many deaf people that duty is not being effectively applied. Again, what action are the Government taking to monitor the implementation of the Act’s duty and what action will they take if it is clear that public authorities are failing in that duty?
We have had some debate about the necessity of interpreting services. I have been contacted by a general practitioner who is particularly concerned about this issue. She tells me that there is currently confusion in the NHS about the funding for interpreters since the reorganisation and replacement of primary care trusts by clinical commissioning groups. My understanding is that in many parts of the country primary care trusts funded interpreting services but, since they were abolished, there seem to be two problems. One is that clinical commissioning groups have not always been prepared to continue to fund those services. Secondly, there has been the issue of how GPs might obtain funding from NHS England, which is the body that they are now in contract with, for interpreting services within their own surgeries. I understand that, while at first some GPs were successful, there are indications that funding is now being withdrawn. That means that GPs will have to pay for interpreting services out of their practice expenses. Again, I would be interested in what the Minister has to say about that.
The noble Lord, Lord Borwick, made an interesting speech and I certainly take his point about literacy and the achievement of the cochlear implant programme. However, I was delighted with the official recognition of British Sign Language some years ago. I recall the bad old days when some deaf children were forbidden to use sign language at school. We have all moved on from that and, for those deaf people who use sign language, it is important that interpreters are available in the NHS. I also share his concern—he raised the point that we debated in October—about whether enough people are coming forward to train as teachers of deaf children. That is a very important point.
I very much take the point raised by the noble Lord, Lord Addington, about online interpretation. He was really saying that that solution was capable of a much wider interpretation than simply talking about deaf people themselves. We must surely be on the edge of a revolution in communications and the use of IT in the health service. This could clearly bring great advantages for many people who find communications difficult at the moment, but I do not think it takes away the responsibility of people in the health service to improve the way they do things now. It is very clear that some deaf people are finding services very inaccessible indeed.
Lord Addington
I totally agree with the noble Lord: it is another way of skinning the cat—that is all.
Lord Hunt of Kings Heath
The NHS has a long way to go to use the technology that the noble Lord has put forward. I welcome the suggestions that he made.
My noble friend Lord Ponsonby asked the Minister a number of questions. I would like to put forward a number of proposals for the Government to consider. For many years, the outcome of health services for deaf people has been overlooked. We are talking about a relatively small group of people—people who inevitably find communication difficult. Will the Government consider the appointment of a national champion—perhaps a national clinical director—to champion health services for deaf people? The clinical directors that the department and NHS England have taken on have been outstanding in giving leadership in relation to a number of clinical areas. I wonder whether, for deaf people in particular, having a champion at national level could help disseminate information and really bang heads together to ensure that much more focus is given to the needs of these people.
Secondly, will the Minister encourage Healthwatch to continue to build on its work to give specific focus on services for deaf people?
Thirdly, will the Minister encourage health and well-being boards at local level to pick up our concerns about across-the-board services? The noble Lord, Lord Addington, made a very strong point about the role of the Minister for the Disabled at national level. At local level, the health and well-being boards could clearly carry out that same function.
Fourthly, will the Minister encourage the development of clinical networks in each local health area so that there is co-ordination of services across primary, secondary and tertiary care as regards the needs of deaf people?
Finally, will the Minister institute regular meetings between deaf organisations and the NHS within each local health area so that there can be proper discussion and debate about the needs of deaf people?
This is a very important debate and I am sure that we all look forward to a positive response from the Minister.