All-Party Parliamentary Group on Deafness

All Party Parliamentary Group on Deafness

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

Location: Committee Room 13, 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

Verbatim Record

The meeting started at 5.30pm

Malcolm Bruce : First of all, can I welcome you all and welcome the Minister who tells me that she has to leave shortly after 6. I actually have to leave a few minutes before that but my colleague Nigel Waterson is going to take over so that we can complete the meeting and what I am going to do is ask the Minister to speak and then there should be an opportunity for questions. You are not just here to watch MPs engage with the Minister. It is your meeting as much as it is ours but I want to thank Rosie Winterton for agreeing to meet us at relatively short notice. We do appreciate that you found the time in your diary. There are a lot of important issues relating to health and access to health services for deaf people but perhaps first of all you can speak to us.

Rosie Winterton : Could I start by thanking you all for inviting me along tonight. Could I say how much as well I appreciate the fact that many people in this room have helped us to develop some very important policies around the issues of deaf people with mental health problems. I very much appreciate the support and advice that has been given and also would like to emphasise how much I hope that we will continue to work together to take forward many of the proposals that are being talked about and of course, we are starting from the very serious and sad fact that there are more people with mental health problems amongst deaf people. There are many theories about that; one is to do with perhaps some deafness may be associated with damage to the brain before birth, but also the fact that many people can feel very socially excluded and the link between social exclusion and mental health problems is of course very well known. There are feelings of isolation that can occur. For example we are aware that only about 10 per cent of parents of deaf children can use sign language. Deaf children are approximately one and a half times more likely than hearing children to have mental health problems and a very high proportion of deaf adults experience one or more common mental health problems such as depression or anxiety disorder. And one of the real issues that I think we need to tackle is the fact that in a wider context deaf people have historically found it more difficult to access health services in general and particularly in primary care where we know that there is a very severe shortage of interpreters and for mental health services where it is vital that communication is strong. Mental Health problems are a terrible thing for people to be facing and it does make accurate treatment and assessment difficult to achieve and that is why we have taken this issue extremely seriously and in the work that I am going to talk about tonight we have concentrated on the prelingually deaf; i.e. those who are either born deaf or who are deafened before the acquisition of speech. These are people who I know are most likely to identify with deaf culture and to use British Sign Language.

Now there was quite a lot of careful thought that went into targeting our work in that area and there were two things that we wanted to do: first of all was to make the task manageable, but we also thought that if we concentrated on that group then we could ensure that the improvements fed through to other groups as well. A further consideration was the evidence that we had that people who are prelingually deaf do face a greater risk of suffering mental health problems and have very particular problems in accessing services and as I have said, there are two reasons for that: one, a lack of interpreters, but also a lack of deaf awareness training for mental health service workers and therefore a lack of knowledge about the specific needs of deaf people.

We launched in July 2002 a consultation document, Sign of the Times, we also produced a video that went alongside that and held a number of meetings throughout the country.

As well as looking at the extent of the challenge that people were facing, and looking at services that people should be expecting in the National Service framework for mental health, the consultation document also looked at a whole range of themes, such as the fact that when mentally ill a deaf person is likely to find a fluid signing environment more therapeutic. We also looked at how we could improve service development and also looking at how the small number of specialist services could be expanded to meet the needs of the deaf community and how we could get local teams to work with PCTs and Social Services. We had an excellent response to that document and once again let me thank people here who whether individually or through organisations responded to that, because I think that it was invaluable in helping us to then go on to develop the implementation guidance Towards Equity and Access. Now that was launched in March of this year and I hope that it has been well received. We are very keen to have a discussion about where people think there might still be problems in that but that is perhaps for afterwards.

Twenty Six specific recommendations about improving deaf people's access to mental health services came from the Towards Equity and Access Report. Some of them, not always just about mental health; some of them a recognition about the difficulties that there can be in simply accessing primary care services in the first place and how we can make that better, but recommendations particularly, for example, that the software which allows translation between English and British Sign Language, which was developed by the charity Sign, that that should be made available to primary and secondary care services as quickly as possible. We helped fund the development of the software and we are now seeing more practices actually taking this up and this is extremely useful, particularly in emergency situations where it can be difficult to get an interpreter quickly.

We have also taken forward work on the development of a healthy living centre for deaf people to see if we can put a range of services under one roof. This proposal is a pilot scheme as suggested in the recommendations and I think that is an extremely important step forward. That is about how we can bring together health and welfare services in the same setting that we know can be beneficial and also can actually help people in many instances through what can be a labyrinth of different services, different information that is available, how can we make that easier to access.

We also want to look at what more can be done for deaf children and we have already developed telemedicine links from the national centre of excellence in London to services in York and Dudley. We know there are very few specialists in this field and we need to make sure that their services are used as effectively as possible. So if we can harness new technology through things like telemedicine then it is absolutely vital that we take advantage of that and what we do want to do is look at whether we can actually expand that service further.

We are also developing a proposal to provide advocacy for deaf prisoners who have mental health problems, a particularly vulnerable group, we think it is important to take forward services in that area.

We are also developing a very important project looking at how we can provide accredited training in deaf awareness to something like 5,000 key health service staff. We know that one of the biggest barriers to accessing health care is that many staff aren't really sure how to respond to deaf people in the first place. So getting that training out there is extremely important.

In responding to the recommendations in Towards Equity and Access, we have backed that up by additional funding and we have made an additional two and a half million pounds in new revenue available; something like one and a half million pounds of this is already in the base lines of primary care trusts and the remainder we are actually holding back so that we can pump prime these national projects that primary care trusts would perhaps be unwilling to fund at this stage. And let me stress that these projects will be either wholly or partly managed by the voluntary sector alongside the health service and really I think that that is a very important development for us to work constructively with the voluntary sector who, after all, have helped us develop many of these projects and, frankly, this is again about if in the health service we try to devise services which are not done in conjunction with service users and those who represent them, then they will not be effective, so it is vital that we have that relationship.

There are a number of projects that we have got in train to develop, but it is also important that we maintain the impetus of the work that we are doing because sometimes these reports can sit on shelves and gather dust. We don't want that to happen, which is why we have set up the Towards Equity and Access Implementation Panel to make sure that the guidance and the recommendations are followed through so that we can see a real difference in terms of mental health services available to deaf people and, again, I do want to thank everybody who is helping us to develop that work. It won't be perfect. I am sure that we shall make some mistakes along the way, but I think as long as we are honest about those mistakes, as long as we are honest about how quickly we can achieve implementation, what further needs to be done and we can maintain the momentum through the Implementation Panel then I think we can make a real difference. So thank you for everything that is being done.

Thank you again to the All-Party Group, because it is so important that the link is kept with Parliamentarians and these issues are raised within the Parliamentary scenario because that does keep us all on our toes and it is good to have fellow Parliamentarians from the Commons and the Lords who are taking this up.

Malcolm Bruce : Thank you very much indeed, Minister. I can certainly say that we welcome the fact that you are engaged in this way, that you have proposals that you are following up and I am sure that there will be questions. I will have to leave in two or three minutes and Nigel Waterson will take over as Chair but can I slightly abuse that by asking the first questions. Firstly, does your department have plans to increase the training provision support for interpreters? Secondly, you mentioned the SignHealth software, what about also voice recognition software which is very helpful for people who don't use sign language, maybe have reasonable speech but have real difficulty in understanding, it is fairly established technology. And finally is it possible for counselling to be made available on the NHS to deaf people earlier. From my experience they can get counselling but are expected to pay for it, where I think they should really be able to get it earlier perhaps than other people.

Rosie Winterton : In terms of the increase in interpreters, that is something that is being taken forward through the DWP. Bob McDonald is one of our senior advisers in this area. Bob, do we have any idea as to numbers of interpreters?.

Bob MacDonald : There are only about 170 interpreters accredited at the right level to say manage a court case or consultation, which isn't a lot to go round and one of the things that we want to do is to provide some of them specialist training in interpreting in mental health settings.

Rosie Winterton : In terms of taking forward increasing the number of interpreters that would be something that we would liaise with the DWP about. In terms of voice recognition, Bob, is that something that can be developed through some of the other projects that are taking place? The idea that it is not just BSL but voice recognition as well.

Bob MacDonald : It is probably going to be more useful for deafened people than people who use BSL but I am happy to make sure that the appropriate officials look at it seriously.

Rosie Winterton : As I said earlier, we have tried to target a lot of these improvements in the first instance.

Malcolm Bruce : I appreciate not everything can be done at once.

Rosie Winterton: In terms of counselling, there is a whole issue about counselling that we have in our manifesto made a very clear commitment to increase the number of complimentary therapies, psychological therapies in general. There are lots of issues around that, some of them are to do with accreditation, and this is another area where I believe that we need to develop the relationship with the voluntary sector because I think there is a lot of counselling that is perhaps already available and getting PCTs to actually commission it then links in with whole issue of accreditation. We have been waiting for a number of the organisations to actually come forward with how they would want to see accreditation developed because it is from societies like the Psychological Society and so on that we have to work with to make sure that what they are doing is coming forward with good benchmarks so that we can then expand the counselling, which makes it much easier to deliver on the NHS as opposed to through the private sector. So there is a whole range, a raft of work that is going on to increase that.

Nigel Waterson : Well I am very happy now to open the discussion and questions up to the floor. When you do ask a question it would be helpful if you could introduce yourself and if you are from a particular organisation, say what it is.

Peter Hindley : I am the Chair of the British Society for Mental Health and Deafness. I am also a child psychiatrist at National Deaf Services, the national centre of specialist excellence you referred to and also chair the Clinical Specialist Network of all of the specialist services. You referred to the role of the specialist services and talked about how you recognise the importance of delivering therapeutic environments in BSL and obviously that is something that has to be looked at with Social Services and also the role of specialist services in supporting service development around the country but one of the key problems at the moment is the impact of PCT commissioning on the delivery of specialist services because unlike most of the other recognised specialist services we don't have national organised consortia to commission our services and that is really having a very significant impact on services across the country and something that causes us very great disquiet really about their future and the future of their ability to deliver services.

Rosie Winterton : Are there any good examples of where it is working well.

Peter Hindley : It is working reasonably well in London, there is a consortia of PCTs working together, but that doesn't apply to the rest of the country and what we have is a mixture of one-off service agreements and named patient service agreements, and really it doesn't function very well and means deaf people have great difficulty in accessing specialist services.

Rosie Winterton : So in a sense what we have to do is use some of the examples of where it worked well to get out around the country, and quite often it can be about actually showing people how to do it and just leading the way in terms of making it easier. One of the recommendations within the report is to look at how that can be increased. Bob, I am not sure whether one of the projects itself is looking at how we spread best practice in terms of the specialist services is it? Or is that something the Implementation Panel is looking at as well?

Bob MacDonald : Lord Warner is about to lead a review of specialised commissioning and we are making absolutely sure specialist mental health services for deaf people are very firmly a part of that so that we can get a better national system working for these very small services that attract people from a wide geographical area.

Rosie Winterton : And therefore we do need to feed into that the experience of London if that is being effective in making sure that commissioning is working properly.

Steve Powell : I am from Sign, the National Society for Mental Health and Deafness. Just to add on to what Peter is saying, one of the concerns we have had over specialist services commissioning is that in 2002 some guidance went out to PCT commissioning and this did include mental health and deafness as being one of those highly specialised services that needed to be looked at differently from the rest but what has actually happened is that has slipped away and as mentioned Lord Warner is now bringing back this agenda but it is indicative of the problem of mental health and deafness in that it is not desperately well recognised within PCTs and therefore unless an emphasis is made then it is very hard to generate that interest. But I would like to thank you because you have done an awful lot personally to enable this process to happen and indeed I saw in the last Health Bulletin that went out recently that Nigel Crisp mentioned again about mental health and deafness.

Rosie Winterton : This is about looking at what is working well at local level and pushing the PCTs in terms of local health needs. Using things like overview and scrutiny committees to look at what is available locally. The responsibility of PCTs is to look at local health needs and to commission accordingly and I think it is right that there is a kind of national Government perspective but it is also important to make sure that people at local level are saying, these are the services that we expect to see locally.

Ian Croft : Good evening, I am from the British Society of Hearing Aid Audiologists. Really this meeting tonight is a little removed from what we do, we are fitting hearing aids. But I was just wondering if deaf awareness training for all people being fitted with hearing aids regardless of private or public provision could help educate people far more to accept the problems that profoundly deaf people have in our society so it became a part of fitting hearing aids, to provide deaf awareness training. We can certainly instigate it because we possibly have more time privately and it can be used as a model to follow through on.

Rosie Winterton : Well, that is something that I will take back to Liam Byrne, who as you know deals with deafness in general, it is an interesting idea.

Peter Bottomley : In Worthing when I first became MP there 8 years ago, there was a 12 month waiting list for a 20 minute hearing test and then an extra 3 months before a hearing aid was fitted. It is now 15 months for a hearing test and 10 months after that for a hearing aid to be fitted. Is this common and how is it to be resolved and how soon?.

Rosie Winterton : I don't know how common that is. Today I have been dealing specifically with mental health issues for Deaf people as opposed to the more general issues but, again, that is something that I could take back.

Official from the Department of Health : I work in the Elderly People and Disability Division of the Department of Health. There is quite a wide variance. We are aware of the variance around the country. There are mechanisms for good practice. Modernising of hearing aid programmes certainly has changed the way that hearing aids are delivered. The problem is now that we are providing digital hearing aids there are real issues. The demand is going up. We are working with PCTs on delivery to develop capacity initiatives. It is an issue and like all other work force issues capacity is usually the bottom line. The British Society of Hearing Aid Audiologists have provided a report and I think it varied from 4 years to 4 weeks. There is an enormous variation.

Herbert Klein : I am one of the Towards Equity and Access Officers working with my colleague Lloyd Wint. We have been involved working trying to get information out into the community and getting in touch with PCTs but one thing that is quite important and worries me is some PCTs aren't aware about the Towards Equity and Access Report, and are not quite sure what to do with the funding for it either. How would you advise us to make sure that PCTs work with the deaf community and to address their needs? Deaf people are quite happy to go and meet the PCTs to advise on their own service but how do you advise us to go about that. That is my first question. My second question is: Is the Towards Equity and Access process time limited or is it ongoing.

Rosie Winterton : It will be an ongoing project, yes. In terms of the issue with the PCTs and raising awareness, we will continue to do what we can from national level. We have put this one and a half million in PCTs baseline budget. We will continue to fund national projects with the remainder of the money. Now very often on these occasions it does take time for things to feed through to local level but it will take that combination of us working at national level, working with organisations through the implementation team, but also representation on the ground and it is important to go to the PCTs, to talk about the specialised commissioning that we need, to get those examples out there as to how we can improve that, but if we can maintain the momentum of the implementation group, I am sure that we won't get a situation where PCTs say they are not aware of the issues. The other thing that I would suggest is that it is quite important to keep up good contacts with the mental health trusts as well because, again, that is something that you can lever in in terms of going back to the PCTs, talking to them about what they need as mental health trusts to be able to access services and, finally I would say that there are a whole range of ways that we can draw attention to these problems, not least through some of the Choosing Health White Paper, public health issues where mental health has been a large part of the emphasis in the public health white paper and we need to link a lot of these together. We need to look at incapacity benefit reforms where we are talking about saying what can we do, what services can be made available to assist people into work and this applies as much, obviously, with the combination perhaps of deaf people and the mental health side of it as well that we need to be bringing in again the whole issue of psychological therapies that can be very supportive in terms of some of the ways that you can work with people who do want to access employment and to be helped back into work in some of those scenarios, so it is bringing together a whole range of policies. This again is something that we need to have a coherent package that all sends the message that it is extremely important that we bring the challenges together and work out the services that can be put together to meet some of those challenges.

Nigel Waterson : I am afraid the Minister does have to go now.

Peter Hindley : Can I just thank the Minister on behalf of the British Society for Mental Health and Deafness for your interest but also for Bob McDonald’s work because he has been a real champion for the work.

Rosie Winterton : And maybe, Bob, if there were any further points that people wanted to make that you wanted to take on board and pass back to me or any of the other wider issues. And thank you for your comments and thank you very much indeed for the time and once again thank you for everything you are doing to make this work.

Nigel Waterson : I would like to thank Rosie Winterton for making the time, particularly when she has the health bill being debated and I am sure we all appreciate it very much. Thank you very much indeed. Our next meeting is with Anne Maguire on the 17th January. I hope some of you can come to that. Thank you very much.

The meeting ended at 6.10pm

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