Deaf patients excluded in NHS rush to digital care

In this extract from a longer piece on the BMJ website about how the NHS’s rush to use digital communications is excluding some patients, there is an examination of the particular issues this throws up for deaf patients.

Even when patients do access primary care digitally, some are receiving poorer care as the result of disability. Office for National Statistics figures published in February showed that 6 of 10 people who died with covid-19 were disabled.10 In November 2020 a report funded by the US Agency for Healthcare Research and Quality and the National Institutes of Health11 warned that video calls made it harder for people with communication related disabilities such as deafness, blindness, and speech disabilities to access healthcare.

“Lots of general practices insist on communicating by phone in the pandemic,” Jean Straus, patient advocate, especially for hearing loss, told The BMJ by phone. “The fact that I can speak with you now is thanks to Bluetooth streaming to my hearing aid. I can speak to GPs using that mechanism, but you have to be assertive to get the technology you need and know what that technology is. Health services that remain telephone only or telephone first remain difficult or impossible for deaf people. How do you book or change an appointment?”

The Royal College of General Practitioners’ current covid-19 advice, taken from the Royal National Institute for Deaf People’s communication tips for health and social care professionals,12 suggests that doctors “ask for and meet communication needs where possible. Instead of using the telephone, where possible use video conferencing tools and add live captioning through video conferencing software.”

“Sign language is a 3D language—it does not benefit from being on flat screen,” explains James Watson O’Neill, chief executive of deaf led healthcare charity SignHealth. “It disadvantages deaf people to be asked to communicate in a way that doesn’t respect the language.”

More than 70 000 deaf people across the UK use British sign language to communicate. Deaf people’s health is already much poorer than hearing people’s, and deaf people often rely on family and friends to interpret for them at doctors’ appointments, but social distancing and stay at home policies made that difficult. There are roughly 1000 qualified registered interpreters in the country, according to SignHealth, and few of them are in rural areas.

In April 2020, SignHealth launched British Sign Language Health Access for on demand access to video sign language interpreters in health settings free of charge. SignHealth spent £800 000 of its financial reserves in the first three months before the NHS agreed to cover the running costs from December to the end of March 2021.13 Funding ran out in March, and the service is now closed.

For deaf patients and healthcare professionals, personal protective equipment can make lip reading impossible. Research by deaf professionals into the provision of transparent or accessible face masks for colleagues found that just 11% of those polled had access to transparent masks.14