For the deaf, good communication is an essential part of every day life. General practice is getting better but there are still ways to improve
Deaf patients who use British sign language (BSL) present a challenge to many GP surgeries. The British Deaf Association (BDA) estimates that up to 80% of its beneficiaries struggle with English. How then do we ensure provision for those whose numbers are few, but have high requirements.
Both the BDA and the SignHealth (deaf health charity) have documented difficulties encountered by deaf people. The BDA has focused on qualitative data in the areas where we work while the SignHealth report Sick of It1 was the largest and most extensive study into deaf BSL users’ health. One finding was: “High blood pressure was almost twice as common in deaf people as in the rest of the population.”
A major reason is deaf BSL patients find making appointments difficult. Sick of It reported that 45% of deaf BSL users book their appointments by attending the surgery. A recent BDA survey in Scotland2 elicited the fact that 60% reported problems in contacting the surgery with 24% visiting the surgery to make an appointment. In north Derbyshire,3 46% reported they attended surgeries to make appointments. Much of this could be avoided by using existing technology such as emails, text messaging and fax messages for making appointments. Clinical commissioning groups (CCG) could take on more responsibility in considering collective action such as purchasing video relay services (video relay services enable the surgery to answer calls from deaf people via a remote sign language interpreter using a computer).
The evidence collected by the BDA and SignHealth also highlights the lack of communication access. For many, this means sign language interpreters. The Sick of It report highlighted that: “70% of deaf people who haven’t been to their GP recently wanted to but didn’t go mainly because there was no interpreter.”
Some surgeries are getting it right with some having a list of locally qualified interpreters; others have a phone number of local organisations working with deaf people that can assist them. GPs could also ask their local CCG to consider a collective response if costs are too heavy for any one surgery.
A lack of clear communication leads to poor diagnosis and deaf patients failing to understand medication application.
Having sign language interpreters will reduce the likelihood of deaf patients not understanding medication. Another option with the patient’s permission is to contact a local organisation that can provide advocacy services so that the advocate can explain what to do with medication.
Another relatively easy solution to improve the waiting experience and avoid missed appointments is to install visual display units announcing the name of the patient along with the doctor or nurse and room number. This linked to a touch screen for patients registering their attendance often works well and reduces pressure on receptionists. A low-tech solution – and often much appreciated – is for the GP or nurse to come out and ask the patient to come into the consulting room.
GP surgeries could also work more closely with local organisations working with deaf people to find solutions. For example, the BDA has been raising awareness and has been active in pushing for deaf people to be involved in healthwatch groups, and in 2015 pioneered training for deaf people to carry out ‘Enter and View’ assessments. These are assessments of how health establishments are providing services to patients for consideration by healthwatch groups.
As part of the Our Health In Your Hands group (a campaign that has been launched for the deaf community and explains one’s right to have a qualified, registered interpreter), the BDA has delivered presentations to deaf people and given out standard complaint letters to encourage them to make their views known. It has also developed a checklist titled, Improving Access for British Sign Language Users: Checklists for Health Boards and NHS Trusts.
The BDA anticipates there will be a demand in England for this kind of information. This stems from the fact that by 31 July 2016 organisations that provide health or adult social care must comply with the new Accessible Information Standard backed by the Health and Social Care Act 2012. Hopefully, before then and after, quotes such as: “My GP surgery is good because they know how to book BSL/English interpreters for my appointments” will become the norm rather than the exception.
Paul Redfern, business development manager, British Deaf Association.
1 SignHealth. Sick of it. 2014. signhealth.org.uk/sick-of-it-report-professionals (accessed 6 October).
2 BDA. Report on Health Services Provision to BSL users in Scotland. 2014. old-bda.org.uk/uploads/BDA/files/BDA_Report_on_Health_Services_Provision_to_BSL_Users_in_Scotland.pdf (accessed 6 October).
3 BDA. Report: Access to GPs in North Derbyshire. 2012 derbyshire.gov.uk/images/BDA%20-%20acces%20to%20GP’s%20in%20Derbyshire_tcm44-252482.pdf (accessed 6 October).