Equal access for all; supporting patients with hearing problems

A Healthwatch report highlighted concerns about the level of deafness awareness training that goes on in practices. Marie Cahalane explores how practice managers and GP partners can make their surgeries more accessible to patients with hearing problems

For patients with additional needs accessing care can pose extra difficulties.

In the UK 10 million people have hearing loss and their experience of using primary care services varies across from practice to practice. While many receive excellent care there are too many instances of frustration, confusion, misunderstanding and a lack of awareness on the part of care-givers.

In fact, difficulties arise on the most basic levels as Dr Roger Wicks, director of policy and campaigns at Action on Hearing Loss, observes, “People with hearing loss often find it difficult to contact their GP when they need to and to understand what’s said in a consultation room.”

 The Disability Discrimination Act requires practices to make ‘reasonable adjustments’ for patients with hearing loss. ‘Reasonable adjustments’ are required if it is impossible or ‘unreasonably difficult’ for a patient with impaired hearing to use the practice.

Adjustments can be inexpensive and as simple as altering the way you provide your service – for example, online appointments rather than telephone. 

Access denied

In 2014 Healthwatch Worcestershire (HWW) surveyed GPs across the area to ascertain the level of service patients with hearing difficulties were receiving and assess the provisions in place. It brought to light a number of issues and made simple recommendations, many with a focus on awareness and practice protocol, to improve the experience of deaf patients in practices.

The report highlighted the difficulties patients had making appointments, a lack of visual prompts in surgeries, the failure of triage systems to adequately accommodate patients with hearing difficulties, inconsistent access to British Sign Language (BSL) interpreters, poor awareness of other modes of communication and a reliance on written communication or on family and friends to interpret.

“What was interesting was that the survey revealed quite a few of our surgeries couldn’t tell us how many deaf patients they had,” Maggie Collins, engagement officer at Healthwatch Worcestershire, recalls. “This got us looking at different solutions.”

An earlier report published in 2012 by Action on Hearing Loss, Access All Areas, which surveyed deaf patients had revealed similar results. It found that 14% of those surveyed had missed appointments because they’d not heard their names called out, over a quarter didn’t understand their diagnosis, one in five said they were unsure about their medication and 68% of BSL users didn’t get an interpreter when they asked for one. Such findings raise issues of health and safety as well as accessibility.

The Accessible Information Standard

From July 31 this year NHS England’s Accessible Information Standard comes into play. The standard offers NHS and adult social care providers guidance to ensure that people with disabilities and sensory loss can communicate well and understand all information.

To help practices meet the standard HWW has outlined key action points that mesh with the advice offered by Action on Hearing Loss. To overcome difficulties making reservations Dr Wicks suggests that, “Practices should provide a range of different contact methods such as SMS Text, email, online booking or Text Relay services.” This is something also recommended in the HWW report.

“In the consultation room health professionals should follow simple communication tips such as speaking clearly, facing their patient and not covering their mouths. A loop system should also be installed and be properly checked and maintained for the benefit of hearing aid wearers,” Dr Wicks advises. However, Dr Wicks warns that relying completely on technology such as loop systems should be avoided as these will not benefit the profoundly deaf.

“The biggest impact for GPs in terms of the new Accessible Information Standard is that they’re going to have to ask people how they prefer to be communicated with,” Maggie says. “We found that patients with hearing difficulties could be saved from waiting for prolonged periods of time if receptionists have records that alert them to a patients’ communication needs. Once aware they can approach the patient and say, ‘It’s your turn, come with me’,” she adds.

Maggie is also keen to see better communication between care-givers where referrals occur. “When a GP refers a patient to the hospital, for example, the patient’s communication needs should be included… There needs to be a joining-up of how records are shared, including what their preference is in relation to communication.”

 Text Relay is a national telephone relay service that helps deaf and those hard of hearing to use a textphone to access services available on standard telephone systems, so the practice requires no additional equipment.

Patients enter the prefix 18001 followed by the practice number into their textphone. When the practice answers a Text Relay operator is engaged. The patient types a message and the operator reads this to the practice staff.

When the member of staff responds the operator transcribes for the patient to read on their phone. 

Raising standards by raising awareness

Dr Wicks encourages practices to invest in training their staff. “Deaf awareness training can provide huge benefits as staff can be taught to break down simple barriers to communication and help people with hearing loss get the most out of their appointment.”

And, as Maggie asserts, “Ensuring your practice caters to all your patients’ needs doesn’t require a huge amount of money to be spent. Front-line staff trained in deaf awareness will know how to meet needs without wonderful visuals, for example.”

A distinction must be made between patients who are profoundly deaf and whose first language is usually British Sign Language (BSL) and patients who are ‘hard of hearing’ – who have developed hearing loss and may depend on hearing loops. While both may face similar basic issues their particular needs differ and there are very specific issues affecting the profoundly deaf.

“Further steps need to be taken if a patient is a BSL user. It is vital that those who need communication support are able to access it,” Dr Wicks stresses. “With communication needs noted on a patient’s care records qualified professionals, such as BSL interpreters registered with the National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD) or the Scottish Association of Sign Language Interpreters (SASLI), can be booked in advance for all healthcare appointments.”

It’s the little things that go a long way. Taking these simple steps can make a trip to the GP a less daunting experience for those with hearing loss and ensure that all patients receive equal access to healthcare.

 Healthwatch recommendations to make your practice accessible

  • Ensure there are a range of options for making appointments to facilitate all patients.
  • Clearly note whether a patient is deaf on their record; have a system in place for notifying deaf patients when they’re called to their appointment.
  • Provide deaf awareness training for all staff who have contact with the public, including receptionists and practice managers.
  • Advertise and promote interpretation provision by displaying posters in surgeries, hospital and council offices to remind staff to book an interpreter and/or making a checklist or leaflet available to all staff as a reminder of their responsibilities to deaf patients and how to book interpreters.
  • Ensure you are asking the right questions; for example, ask patients about their preferred mode of communication.
  • Adopt simple visual indicators in waiting rooms and reception areas.
  • Consider access to services for deaf people when tendering and reviewing contracts.
  • When a patient with hearing difficulties is referred to other services make sure to include that the patient is deaf or hard of hearing.

This article first appeared in a previous issue of Practice Business


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