Access & Inclusion (Health) Review: Deaf BSL users’ engagement with health care in Scotland

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Summary

For this survey, which is part of the wider Deaf Health Challenge project funded by the Scottish Government, BDA Scotland has gathered information from BSL users across Scotland about their experiences of using health services. 189 people were consulted in 13 different groups.

Findings

Most participants were unsure about which services were part of primary healthcare and which were secondary. Overall, they found communication better in primary care settings, such as with a GP, because staff usually know them better and know about their communication needs. Secondary care was considered more problematic: participants reported that they had often turned up to appointments only to realise that no BSL/English interpreter had been booked, or that they did not know the BSL/ English interpreter who had been booked (this was especially problematic when the BSL/English interpreter was the wrong gender e.g. woman patient with male BSL/English interpreter.

NHS staffs were generally found to be easier to communicate with when they were part of a local service that Deaf patients used regularly, although staff rotation sometimes caused problems. Some participants said they took family members or friends to all appointments in case no BSL/English interpreters were provided. Staff with BSL / Deaf awareness and some BSL knowledge were considered very helpful.

While participants usually received a letter telling them about a referral to a hospital or clinic, they often did not understand why. This is because the letters were difficult to understand or did not include enough information, or because the GP did not explain the referral. This made Deaf patients very worried; they did not understand why they had to go to hospital and only found out at their appointment that there were no serious problems.

Most Deaf patients said they preferred to contact their local health services via text, email or Text Relay. When this is not possible, they preferred to make appointments face-to-face. Most participants had never heard of or used the online interpreting service contactSCOTLAND-BSL. Those who had tried it reported technical problems, such as unreliable connections.

Overall, participants said they were more comfortable in the familiar environments of their primary care services. Secondary care services can be faster, even though more complicated as they involve more staff and different departments.

While some respondents said they would recommend their local NHS services if they were used regularly and staff had good BSL/Deaf awareness, many would not recommend their local services. Services were said to vary in BSL/Deaf awareness and many did not provide BSL/English interpreters or did not know how to book them.

Many participants used public transport to get to hospital appointments. Only a few used Ambulance Patient Transport Services (PTS) because they could not use public transport. They were unhappy because PTS was found to be very inflexible and uncomfortable, as respondents could not communicate with other patients during a trip. One worry is that the first members of staff that Deaf people meet are usually paramedics (ambulance), who are not trained at all in BSL/Deaf awareness.

Those who had attended A&E stated that they communicated via a writing pad, a family member or a friend. They would like NHS staff to be more aware of the different communication methods that can be used with BSL users, such as online interpreting via iPads, written plain English and the BSL/English interpreter booking system.

It was highlighted that, unlike in England, there is no residential mental health service available in Scotland that specifically caters for Deaf people. Those who had used mental health services before did not receive enough support. Some participants knew a mental health professional socially and were therefore concerned about using their services. They felt that mental health support could be improved if more professionals learnt BSL and were more BSL/Deaf aware.

Most participants did not know about Pathway Support (diagnose health problem from start to end) for long term illness, or what it does, but were interested in finding out more.

Overall, it became clear that Deaf patients were usually more successful accessing services they were familiar with, but struggled upon referral to secondary care. A major issue was the lack of BSL/Deaf awareness among NHS staff and the failure to book BSL/English interpreters. Writing letters was not thought to be useful, as Deaf patients often did not understand the content and got confused, which sometimes led to them being treated without giving consent. BSL/English online interpreting services were rarely used because of technical problems. The short notice availability of BSL/English interpreters is a problem, particularly in A&E, so that a compromise may have to be found while waiting for the preferred BSL/English interpreter to arrive. The lack of residential mental health services and community support initiatives that are suitable for Deaf BSL users remains problematic.

Plan for this year:

Gather more information from Deaf community (from whole of Scotland) through surveys/consultations.

Spread more information across NHS boards and voluntary organisations (Chest, Heart and Stroke Scotland – CHSS, Action on Depression, Dementia, COPD, and Multiple Sclerosis – MS) in Scotland, including problems and areas for improvement.

Research other health related topics relevant to the Deaf community, e.g. Chronic Obstructive Pulmonary Disease (COPD) and stroke.

Continue to work with the NHS, voluntary organisations and health promotion agencies to provide a presentation about BSL/Deaf Awareness training and BDA’s report “Access & Inclusion (Health) Review: Deaf British Sign Language users’ engagement with health care in Scotland”.

Deliver presentations to health boards and health providers to raise awareness of the Deaf community and their experiences.

Deliver BSL/Deaf awareness presentations to trainers for health service providers.

Contribute to the BSL national plan regarding Deaf people’s health, as part of the BSL (Scotland) Act (2015).

Work with BSL Health Champions (NHSGGC), Deaf & Mental Health Working group, Voluntary organisations (MS, Action on Depression, CHSS, Dementia) and contactSCOTLAND-BSL (advisory group), and support their service development, based on the information gathered in this survey.

Work with the NHS and voluntary organisations to establish the BDA’s BSL (Scotland) Charter.

Recommendations:

Communication between primary and secondary health care providers should be improved so that patients’ communication needs can be shared between all relevant departments. Procedures for booking BSL/English interpreters should also be improved.

Staff should be given the opportunity to attend BSL/Deaf awareness training.

Appointment confirmation should be possible by means other than telephone; e.g. by text messaging.

A cautious approach should be taken in the development of BSL/English online interpreting services. The issues affecting patients’ face-to-face access to health service information should be remedied prior to BSL/English online interpreting services being rolled out. A more productive short term aim would perhaps be to address weaknesses such as booking systems; the availability of BSL/English interpreters at short notice in other areas affects the consistent provision of face-to-face interpreters across departments.

Consider provision of basic BSL/Deaf awareness training for paramedics and ambulance staff, to help them to communicate with Deaf patients. Or, if practicable, they could be provided with BSL/English online interpreting equipment (ipads/mobile phone) such as Deaf people rather to use it because it is easier to access, to help to address existing communication issues.

A&E staff need to understand the importance of booking a face-to-face BSL/English interpreter in emergency situations and should also be aware of other communication strategies, such as online interpreting or written materials where this is suitable.

It is worth considering setting up a mental health service for Deaf people in Scotland, perhaps borrowing from successful initiatives established in other NHS Board areas throughout the UK such as the National Deaf Services e.g. John Denmark Unit (JDU) and others, in England. Deaf people may prefer a Deaf mental health service; this would be Deaf aware, and BSL will be used in it; in mainstream mental health services, BSL/English interpreters will be required.