A simple cure
RNID is the largest charity representing the needs of the nine million deaf and hard of hearing people in the UK. Here, Martin Harris reveals how deaf and hard of hearing people face restricted access to the National Health Service and what can be done to overcome these barriers.
Good communication with patients is fundamental to good health care. Without it, diagnosis may be based on misleading or incomplete information. Treatment or preventive care may fail because the patient cannot grasp the advice or dosage instructions. Patients may even not get to the right place at the right time to be seen. The prevalence of deafness is much higher among older people: more than 50 per cent of people over 60 have some loss of hearing.
In 2004, RNID published its report, A Simple Cure, which carries the findings of a national survey of these people’s experience of the NHS. It makes for disturbing reading by highlighting the extent of the communication failures between health professionals and the one in seven of their patients who are deaf or hard of hearing. The results reveal a health service that has yet to make the changes necessary to meet the needs of deaf and hard of hearing people and be compliant with the Disability Discrimination Act (DDA).
A worrying situation
Over 800 deaf and hard of hearing people responded to RNID’s survey:
* worryingly, 42% of those who had visited hospitals in a nonemergency capacity said they had found it difficult to communicate with NHS staff
* in primary care settings, over a third (35%) of deaf or hard of hearing respondents had been left unclear about their condition because of communication problems with their GP or nurse.
‘The medical profession simply does not understand how to communicate with deaf people. They either mumble or speak very loudly. I despair of the training of my GP! So there are always problems in being sure of what a doctor or nurse is saying.’
Frank, 81, who lives in Reading
Only a small proportion of deaf and hard of hearing people use British Sign Language (BSL). But for those who do, the communication barriers are particularly threatening to the delivery of appropriate care:
* a third (33%) of BSL users said they had either been unsure of the correct dosage of medication to take, or in fact had taken too much or too little medication, because of a communication problem with their health professional
* 70% of BSL users said that accident and emergency units were not provided with a sign language interpreter, making an already stressful and critical situation much worse.
In addition to the detriment to health care, RNID fears that the cost implications of not acting on this report are profound: a quarter (24%) of deaf or hard of hearing patients had missed at least one appointment due to poor communication. RNID estimates that the cost to the NHS in terms of missed appointments alone is £20 million a year.
A loud and clear message
Overcoming communication barriers is not as difficult as it appears, as most of the required measures are simple and inexpensive. But it does require awareness among NHS staff of deaf people’s needs – currently at the root of the problem – and some thought about appropriate adjustments.
It is essential to understand the obligations that are now placed upon all service providers by the 1995 DDA. It states that when providing goods and services to the general public, it is unlawful to refuse to serve a deaf or disabled person, Or to provide them with a service of a lower standard’ or on worse terms. Given that one of the fundamental principles on which the NHS is based is equity in healthcare provision, it seems to be a very obvious point to make. Unfortunately, we find that we need to do just that. Furthermore, at a time when there is increasing emphasis on ‘patient choice’ and the active participation of patients as partners in their own programme of care, there is a real danger that patients who are easy to communicate with, will get a superior service. It is therefore essential to optimise communication with deaf and hard of hearing people as well as with users of minority languages.
According to Dr John Low, chief executive of RNID, the NHS can easily address this situation with simple and cost-effective solutions. Minor investment in simple technologies such as visual alert displays and loop systems will improve access and help lower the number of missed appointments. To be truly effective, however, this investment needs to be followed by deaf awareness training for all frontline NHS staff.
Basic ‘deaf awareness’ techniques
* Deaf and hard of hearing people have different preferred communication methods, but there are some simple steps that can be taken to improve communication. Remember that even if someone uses a hearing aid, they may need to lip read as well.
* Ask patients how they prefer to communicate and mark their notes, so that other staff are aware. (There should be a procedure for finding out in advance of an important consultation whether there is a need for a sign language interpreter to be present.)
* Ensure that your immediate environment is as quiet as possible.
* Stand or sit as close as is polite.
* Face each other so that your patient can lip read you.
* Position yourself with your face to the light and avoid placing yourself in front of a bright window: this will enable the deaf person to obtain the best view of visual clues, such as body language, facial expressions and mouth movements.
* Remember to speak clearly, maintaining a normal rhythm of speech.
* Do not shout.
* Avoid jargon and unfamiliar abbreviations.
* Sentences and phrases are easier to understand than isolated words. If a word or phrase is not understood, use different words with the same meaning or, if that fails, try writing it down.
* Remember to keep hands, pens and instruments away from your face while speaking.
* Remember not to continue talking if you turn away to pick up something or to use a computer or other equipment.
* Check that your patient has understood you properly.
Using technology to its best advantage
* Loop systems: at reception desks, these help people who use hearing aids to hear what is said more clearly by transmitting the receptionist’s speech to the hearing aid and reducing background noise. They are easily installed and cost as little as £60.
* Visual alert/call systems: in waiting areas, these can help ensure that deaf people do not miss appointments because they have not heard announcements.
* Textphones (often known as ‘minicoms’): people who are severely or profoundly deaf may use a textphone to communicate with other textphone users directly, or with hearing people via RNID Typetalk. Textphones have a display screen and a keyboard allowing you to type what you want to say and read what is being typed in reply.
* RNID Typetalk: many deaf people use textphones. If you have a voice telephone and want to talk to someone who has a textphone, or vice versa, you can you use RNID Typetalk, the free national telephone relay service run by RNID and funded by BTTo access Typetalk, dial 18002 and then the number in full (remembering to use the area code). All reception staff should be trained in how to use RNID Typetalk.
* Video interpreting: deaf people who use BSL can use videophones to communicate in sign language. With fewer than 200 registered sign language interpreters available, it can be difficult to book an interpreter to be present at a medical consultation. Video interpreting alleviates this problem by providing easy access to professional interpreting at short notice. The service connects the people involved in a consultation via videophone to an interpreter at RNID offices. There are certain settings within the NHS that lend themselves better to video interpreting than others. To access this service, please telephone/textphone 0870 765 7446.
In long-term care settings, it is also essential that care staff understand the basics of hearing aid use and maintenance. There is also a need for provision of additional listening devices and alerting systems.
A Simple Cure makes several recommendations for changes to ensure that the health service meets the needs of its nine million deaf and hard of hearing users. These include:
* widening the use of existing technology, including visual alert displays and loops systems
* deaf awareness training for all medical and nursing undergraduates
* the instigation of NHS training seminars to ensure all GP surgeries and hospitals have at least one frontline member of staff who has been formally trained in deaf awareness and practical communication skills
* all written communication, such as letters confirming appointments, to be written in clear English for British Sign Language users
* an updated NHS Disability Access Audit which includes the needs of deaf and hard of hearing people
* access to video interpreting technology in areas where there is a high concentration of BSL users.
RNID is also talking to every major body responsible for commissioning health services throughout the UK, explaining what changes are needed in order to provide a truly equal standard of service to deaf and hard of hearing people.
Joining RNID is essential if you are at all affected by deafness, hearing loss or tinnitus. You will receive our award-winning members’ magazine, One in Seven, which includes reviews of the latest products, interviews, news and real-life stories, and addresses many questions about deafness, hearing loss and tinnitus. If you are not already a member, telephone the membership team on 0845 6340679 or visit www.rnid.org.uk/join to find out more.
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RNID (2004) A Simple Cure. London: RNID.
Membership Officer, Royal National Institute for the Deaf
Copyright Pavilion Publishing (Brighton) Ltd. Jun 2005
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