All-Party Parliamentary Group on Deafness

All-Party Parliamentary Group on Deafness

Pre-briefing for APPG on Deafness meeting – 29 November 2005

Date & Time: 5.30pm – 6.30pm, Tuesday 29 November 2005

Location: Committee Room 16, Committee Corridor, Palace of Westminster

Speaker: Rosie Winterton MP, Minister of State for Health Services

Chair: Malcolm Bruce MP

Contact: Jonathan Isaac, Director, UK Council on Deafness and Clerk, APPGD j.isaac@deafcouncil.org.uk

Introduction

The Minister will be speaking to the Group on progress being made in implementing the recommendations in Mental Health and Deafness – Towards Equity and Access, the March 2005 Department of Health report into the provision of mental health services for deaf people and deaf people’s access to general health services.

The Minister’s responsibilities include mental health; prison healthcare; and equality and diversity issues.

Background

Towards Equity and Access

In July 2002 the Department of Health launched a consultation document entitled Sign of the Times focussed on Deaf people who use sign language and considered how well their mental health needs were being met. The consultation was extended into 2003 to allow the many organisations working with deaf people who wished to contribute an opportunity to do so. Local organisations worked extremely hard to engage their Deaf Communities and service users in the process. The voluntary organisations involved in deaf issues and the providers of specialist services played a major role in the consultation, ensuring a high participation rate by the people most affected by the proposals. The many responses welcomed a focus on what they perceived to be a neglected area and service providers, advocates and users worked together to produce a considerable number of well-considered responses.

There was a widespread view that the level and organisation of mental health services for Deaf people was far from adequate and that progress needed to be made if people were not to feel excluded from services. The words “equity” and “access” were used many times in responses and these were reflected in the title of the resulting report: Mental Health and Deafness – Towards Equity and Access, published in March 2005 by the Department of Health. The report makes 26 recommendations forimproving the provision of mental health services for deaf people and, recognising that provision of general health services impact on people’s mental health, on deaf people’s access to general health services. The government committed an additional £2.5 million annual recurring funding to help the NHS implement the recommendations.

A Simple Cure

In the spring of 2004, RNID, in partnership with UK Council on Deafness and in collaboration with many local and regional organisations working with deaf people, carried out research into the experiences of deaf and hard of hearing people when they visit their GP surgeries and hospitals. The principle objective was to establish whether evidence received regularly by the participating organisations suggesting widespread poor quality treatment was reflected in reality. The main findings of the resulting report; A Simple Cure, A national report into deaf and hard of hearing people’s experiences of the NHS published in March 2004 by RNID, were that, resulting from communication problems;

35% had experienced difficulty communicating with their GP or nurse

15% said they avoid going to see their GP; this doubles among sign language users

28% found it difficult to contact their GP surgery to get an appointment

35% had been left unclear about their condition

33% of sign language users were either unsure about instructions for medication, or had taken the wrong amount of a medication

24% had missed an appointment for simple reasons such as not being able to hear staff calling their name; 19% of whom had missed more than five appointments in a year

In hospitals;

42% of deaf and hard of hearing people who had visited a hospital (non-emergency) had found it difficult to communicate with NHS staff. This increased to 66% for sign language users.

70% of sign language users admitted to A&E units were not provided with a BSL/English Interpreter to enable communication.

The evidence demonstrates a disturbing picture where deaf and hard of hearing people face difficult and often distressing obstacles in order to access the NHS.

The Disability Discrimination Act requires the NHS to make all ‘reasonable adjustments’ to ensure their services are fully accessible. Many adjustments are cheap and readily accessible and yet the widespread evidence shows that they are not being put in place.

Basic Rights

To further assist improvement in access to mental health services for deaf people, in October 2005 the Mental Health Foundation and SIGN, the National Society for Mental Health and Deafness produced a service provider’s guide; Mental Health and Deafness – Addressing Basic Rights. The guide aims to raise awareness of the basic rights of deaf people when receiving mental health services and gives those commissioning and providing mental health services essential information on mental health and deafness in order to make services more inclusive.

Implementing Towards Equity and Access

To support the NHS in implementing the 26 recommendations in Towards Equity and Access the Department of Health, in collaboration with the British Society for Mental Health and Deafness, set up the Towards Equity and Access Implementation Panel, with members drawn from NIMHE (now part of CSIP), the NHS, Voluntary Organisations, Specialist Services and Users.

The Panel was convened in July 2005 and has since met regularly to oversee implementation of the recommendations and to provide support to PCTs. The Panel identified that by distributing the additional £2.5 million funding to 303 PCTs there were practical difficulties in addressing those recommendations that required a national solution and in November 2005 the Panel proposed to the Department of Health a number of national initiatives that had been submitted by Voluntary and Public Sector organisations. Agreement has been secured to fund these proposals by pooling a proportion of the funding centrally. It is anticipated that most projects will start in January 2006.

The Issues

1. The NHS is demonstrably in breach of the DDA. Despite all of the positive initiatives from the Department of Health and Voluntary Organisations, PCTs are failing to put in place the reasonable adjustments required to make their services accessible to deaf people. This is denying deaf people their basic right to equitable access to health and mental health services. A typical report from a deaf person having visited their GP is: “When I asked my GP about Deaf Awareness Training she said she had never received any and did not have a clue how to cope with Deaf people (there are over 20 BSL users registered with the practice) but more importantly "did not have time to bother"

1. The Commissioning of Specialist Mental Health Services. In 2002 the Department of Health issued guidance to PCT's on commissioning highly specialist services. This document addressed the fact that with a move to PCT commissioning those services that were low incidence but highly specialist and therefore expensive and unfamiliar to local commissioners may retract in the absence of national or super-regional commissioning. As a result the funding of these services could be jeopardized. The document listed 12 services, including Mental Health and Deafness. There are only three adult and three child and adolescent mental health services covering the whole of the UK. Subsequent changes in commissioning of services (named patient service agreements, etc) have shown the concerns highlighted in the 2002 guidance to be realised. With a few notable exceptions, PCT's have not established regional specialist commissioning for Mental Health and Deafness as they have for other services such as Cleft Lip or Haemophilia. Lord Warner who has been asked to look at specialist commissioning has not specifically listed Mental Health and Deafness in the group of conditions to be reviewed. The absence of effective specialist commissioning poses a significant threat to the short and long term functioning of the specialist services.

1. PCTs are not using the funding made available to them to implement the Towards Equity and Access recommendations. There are a few examples of good practice, in London for example the PCTs have pooled their funding to ensure it is more effective. However there is overwhelming evidence that the vast majority of PCTs are unaware of the report, are unaware that they have received the funding and have not used it to implement any recommendations. PCTs have been contacted to ask them how they are spending the money. Over 90% of them were not aware of receiving it. A typical response, from Bexhill and Rother PCT, sent to Michael Foster MP, states: “We have no contracts aimed specifically at improving services to help the deaf community…. there is no ring-fenced funding available…” Indeed there is evidence that in some PCTs the funding has been used to reduce end of year deficits.

1. The Voluntary Sector has an excellent record of working with the Department of Health to deliver on health objectives. The work of the RNID in modernising Audiology services and providing digital hearing aids is an excellent example. Voluntary Sector delivery can ensure patients are directly involved in their healthcare, it can be highly cost effective, clearly measurable and to some extent can be independent of the organisational changes within the Health Service which sometimes prohibit outcomes. With the imminent restructure of PCTs and SHAs there is concern that the Towards Equity and Access recommendations and monies will be lost. The voluntary sector is clearly capable of delivering on many of the recommendations of the Report, in the short and the longer term, and the Department should be encouraged to make greater use of this valuable resource.