Health: Deaf People

Lord Ponsonby of Shulbrede Excerpts

Monday 31st March 2014 Lords Chamber

Asked by

[Lord Ponsonby of Shulbrede]

To ask Her Majesty’s Government what measures they intend to take to improve the health of deaf people.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, I open by thanking the Minister and noble Lords who are going to take part in this important debate. It is about deaf people, by which I mean people who are born or become profoundly deaf before the age of five. They usually prefer to communicate in British Sign Language and see themselves as part of the deaf community. By this definition, there are an estimated 70,000 deaf people in the United Kingdom.

I am speaking to a deaf health study called Sick of It, launched last week, on 25 March, which is the largest and most extensive study of the health of deaf people in the world so far. Most of the study was funded by the Big Lottery Fund and carried out by the charity SignHealth in partnership with the University of Bristol. I am particularly indebted to Dr Andrew Alexander, SignHealth’s medical director, who provided me with the briefing for this debate.

Before now, there has never been any research on this scale into the health of deaf people in this country. Although there have been a few small studies looking at access to health—all found it poor—no Government have ever specifically addressed the health of deaf people as I have defined them here. The closest initiative was Mental Health and Deafness—Towards Equity and Access. Although this started as a consultation on mental health, it included a lot on the wider barriers faced by deaf people. The report was supported by funding which was received by each primary care trust to help it implement the recommendations of the report.

Deaf health rarely features on any agenda, with the notable exception of that of the House of Lords. Even within health and equality programmes, attention is normally focused on groups with a higher profile. It does not help that being deaf is a hidden disability and that there is so little awareness of the barriers that deaf people face. This is usually the case on the health front line as well. Most staff will think that speaking louder or writing things down will solve the problem. When surveyed, a very high percentage of doctors wrongly thought that they had communicated well with their deaf patients.

I turn to the report’s methodology and findings. There were three stages to the report: first, an online survey was conducted by Ipsos MORI; secondly, personal health assessments were made of 298 deaf people, including looking at their blood pressure and BMI and taking blood tests, et cetera; thirdly, there were in-depth interviews of deaf people. The findings were as follows. First, underdiagnosis and undertreatment of potentially serious conditions was more common for deaf people. Secondly, high blood pressure was almost twice as common in deaf people as in the rest of the population. Thirdly, deaf people have generally healthier lifestyles than the rest of the population in terms of smoking and alcohol but are more likely to be overweight. Fourthly, there is underdiagnosis: deaf people are twice as likely as hearing people to have high blood pressure that has not been diagnosed and may also be more likely to have undiagnosed diabetes, high cholesterol and cardiovascular disease. Moving on to poorer treatment, the report also found that when deaf people have been diagnosed, they are more likely to be on inadequate treatment for those conditions. It has been estimated that if the deaf community had the same health profile as the general population, the NHS would save about £30 million per year.

I will now talk about access and communication. A large number of deaf people reported not seeing their GP because they were put off by the prospect of poor communication. A large proportion booked appointments by going to the practice in person—some 45%—whereas very few hearing people book appointments in this way. Only 15% of deaf people said that their GP was good at listening to them, compared to 51% of the general population. At most, 30% could use BSL in a consultation even though, in total, 94% would prefer to sign. More than half had to use an English-based form of communication—for example, lip reading or writing notes—but only 5% would prefer to communicate in that way. This disparity between how deaf people have to communicate and how they would like to communicate is an indictment of the health service, and an explanation for the poorer health outcomes of deaf people. Only 25% of deaf people have confidence in their doctor, compared to 67% of the general population.

There is also a wider issue about access to information. Because health information is not widely available in an accessible format, a lot of the deaf people studied were unsure about their health and unsure what their prescriptions were for or how to take their medicine. While many hearing patients would find out more information from friends, family or the internet, these options were less available to deaf patients. As a result, few of the deaf people interviewed through the in-depth process appeared actively engaged with their own personal health management.

What are the prescriptions for change? I should just say that change from the point of view of the deaf community is about equal rather than special treatment. The first prescription is that systems within the health service need to be accessible. From booking an appointment to getting test results, there should be a communication agreement for each deaf patient, which is then coded and recorded in their patient record. Secondly, deaf patients should be able to book appointments online and be able to use texts to communicate with services. Thirdly, deaf patients should be able to communicate during consultations in their preferred language. Health services must expect and plan for deaf patients. Clinicians should remember that interpreters are not just for deaf people but help the doctor to understand and diagnose properly. Fourthly, providers must make sure that staff know how to book an interpreter and ensure that interpreters are suitably qualified. Fifthly, health information needs to be made accessible in other formats, including BSL and subtitles. Currently, only 10 out of a total of 900 NHS Choices videos are available in BSL. The proposed information standard on accessibility should be supported with a funded programme.

I move on to some questions, which I have given notice of to the Minister. First, are there any plans to ensure that NHS Choices increases the number of videos available in BSL? Secondly, what would the Minister recommend to a deaf person who wants to see a doctor but is told no interpreter is available or that it is too expensive? It was brought to my attention earlier today by Dr Clare Redstone, a GP, that it is very common to experience problems in booking interpreters. Thirdly, what steps will the Government take to encourage the NHS Executive and Public Health England to promote the health of deaf people? Fourthly, when can we expect the NHS computer system to be able to tell us how many deaf people there are and which services they are accessing? Fifthly, will implementation of the proposed information standard be supported with a funded programme which can help to educate and support health services?

My sixth question is one that I sent the Minister earlier regarding whether psychological therapies providing BSL should be the responsibility of specialised commissioners. I understand that the Minister has since decided that psychological therapies for deaf people should not be on the list of prescribed services. Therefore, in the updated situation, my question is: how can we ensure that psychological services nationwide are available for deaf people? I understand that there is a very patchy covering at the moment. Lastly, what does the Minister think would be the best way to raise deaf awareness among staff working in the health service?

I look forward to the Minister’s response. I understand that she is working on a cross-governmental strategy on hearing loss and that the report on this is ongoing. My debate today is about a very specific cohort within that deaf community, and I hope that she will be able to address the questions that I have raised.