Updated: 14 May 2020
This statement provides an overview of the key issues affecting people who are deaf or have hearing loss in the context of the UK’s coronavirus response. It also sets out Action on Hearing Loss’ recommendations for action.
There are 12 million people in the UK with hearing loss, including an estimated 900,000 with severe or profound hearing loss. We know that it is older people who are at higher risk of becoming severely ill due to coronavirus. With more than 70% of people over the age of 70 living with hearing loss, the needs of this group must be taken into consideration in the UK’s response.
Due to the fast moving nature of events and changing guidance, Action on Hearing Loss will update this statement on a rolling basis. If you would like to confirm that you have the latest version, or for further information, please contact:
Ayla Ozmen, Head of Research and Policy:
- 07787 538267
1. Accessibility of public health information
The Equality Act requires reasonable adjustments to be made to support disabled people, including providing information in an accessible format. The Accessible Information Standard (AIS) puts a legal requirement on all health and social care providers to provide information in people’s preferred format. People’s rights under this legislation must be upheld, even in these unprecedented times. We have written to the Prime Minister calling for urgent action in this area.
We welcome that the majority of audio public health messaging currently available is subtitled. A large proportion of current public health messaging, however, remains inaccessible to British Sign Language (BSL) users. For many of those whose first language is BSL, reading written English can be difficult. Critical information on the GOV.UK website for example, including recent information on testing, is not translated into BSL. There has also been no suggestion that the contact-tracing app being proposed will be made accessible to BSL users.
We welcome the Governments publication of short BSL videos including basic public health information. The content of these videos, however, is extremely limited and they haven’t been widely disseminated. SignHealth, the Deaf health charity, has produced BSL versions of some public health information, though these haven’t been widely promoted by the Government and public heath messaging will continue to evolve rapidly with no clear plans for BSL interpretation or dissemination.
With regard to broadcast media, BSL versions of the day’s news are available at limited intervals of the day. With significant announcements being announced at short notice however, timely access to information has become more important than ever. Government’s decision to work with broadcasters to provide BSL interpretation for the daily press conferences was therefore a very welcome step that should continue. There was, however, unfortunately no BSL interpretation for the critical announcement that took place at a slightly later time on 23rd March or for the Prime Minister’s return to work speech on 27th April.
The shielded patient list comprises people who are considered at the highest clinical risk of severe illness from coronavirus. The individuals currently on this list have been identified by a clinical algorithm developed by NHS digital and all those identified have been sent a letter to inform them that they should stay at home and avoid all face-to-face contact for a period of at least 12 weeks. We welcome the recent production of a BSL version of this letter, though promotion of this has been limited.
The letter not only informs people of the actions they should be taking to protect themselves but also advises people to visit the Government’s website to register for support with obtaining food packages or medications.
We understand that the national shielding helpline is calling people who are on or should be on the shielded list to share this information and understand their support needs. However, the telephone is an inaccessible method of communication for people who are deaf or have hearing loss and we are concerned that people will not be made aware of this critical information and peoples’ needs will not be properly assessed.
We also understand that the Government is currently working with GPs, hospital clinicians, local councils and the voluntary sector to identify all those who should be on the list and who require support. We know, however, that health services are currently inaccessible to many (see below) and in addition, we have seen that many local authorities supporting these efforts are not providing accessible contact methods.
The Government should identify a national senior lead to advise on the accessibility of all coronavirus communications.
The Government should provide and publicise comprehensive, timely public health information in BSL and ensure BSL interpretation for all daily televised coronavirus briefings and announcements.
The Government should effectively disseminate the BSL version of the letter to those for whom shielding is recommended.
The Government should continue to work with GPs, hospital clinicians, local councils and the voluntary sector to ensure that people on the shielded list who have communications needs are identified and supported in a way that is accessible to them.
2. Accessibility of health and social care services
Remote appointments, PPE and communicating with people with hearing loss
People who are deaf or have hearing loss rely heavily on visual cues for effective communication. These include body language, gestures, facial expressions and lip reading. Being able to see lip patterns and facial expressions is also vital for those who communicate through BSL.
People are currently being encouraged, and choosing, to have health appointments over the telephone. For many people with hearing loss, telephone conversations will be difficult or impossible. For some, in some circumstances, video conversations will also be difficult.
Under the AIS, all health and social care providers must identify, record and meet people’s specific communication needs, many of which will have, until now, been met by face to face contact.
Our Good Practice research report showed that only 1 in 10 people with hearing loss had been asked about their communication needs in line with the AIS. In addition, we know that 9 million people have unaddressed hearing loss and people take an average of 10 years to seek help for their hearing loss. So many whose communication needs have not been identified will also struggle to communicate remotely.
People who are deaf or have hearing loss have also told us that they are struggling to communicate with health and social care professionals during face to face consultations and interactions. A particular challenge comes from visual cues being masked by Personal Protective Equipment (PPE). Those health and social care professionals who themselves have hearing loss are also struggling with this barrier. Whilst we of course want to keep people as safe as possible and advocate following current public health guidance to ensure this, for some people with hearing loss in health and social care settings a safety risk can also be presented by inaccessible communication.
We are aware of designers in the UK exploring options for the development of clinically safe masks that also enable lip reading. We are also supporting research into this area. Though no approved masks are yet available in the UK and any such venture will take time. In light of this challenge, we have been made aware of some health and social care services attempting to source masks with a clear window currently manufactured in the US and some are advocating the use of face shields alone. We understand, however, that the clear masks manufactured in the US are not currently approved for use in health and social care settings, as they do not provide adequate protection to staff. In addition, current Public Health England guidance does not recommend the use of face shields alone. We fear that in the absence of clear guidance on this from Public Health England, in some cases, PPE may also be removed altogether, in order to address this significant barrier.
In these exceptional circumstances and whilst ensuring adherence to current public health guidance, however, accessible standards must still be upheld. There are simple options that will improve the accessibility of services for those who are deaf or have hearing loss. These include adopting communication tips to ensure understanding in telephone conversations or when wearing PPE; using screens where possible; utilising Video Relay Services; and using written information as well as verbal. See our communication advice for health and social care professionals here. See also, communication advice produced in conjunction with other charities here.
BT provides the only text relay system across the UK – its Relay UK system. Every communication provider is required to provide access to a text relay service under the Universal Service Obligation, which in effect means Relay UK. The system is required to answer over 90% of calls within 15 seconds, and 95% of emergency calls within 5 seconds.
With many now unable to access services or make appointments in person, this service is experiencing a substantial increase in demand. We have been made aware of waits of over an hour for health appointments. Though understand that the service is now meeting targets again. We are continuing to monitor this situation.
If people are experiencing coronavirus symptoms, they are currently being directed to access the NHS111 service via an online form. If, however, upon completion of the form, you are suspected of having coronavirus and your symptoms are severe i.e. you are so ill that you have stopped doing all of your usual daily activities, you will be directed to call NHS 111 for further clinical advice.
There is also the option to access the NHS 111 service via textphone or the Text Relay service and we welcome the move from BT and Ofcom to ensure that calls to NHS 111 are prioritised at a time when the Relay UK service has unusually high demand. This service can be used at any time, though is not currently being widely promoted.
BSL users can also access NHS 111 using the Video Relay Service at www.interpreternow.co.uk/nhs111 or by using the InterpreterNOW app on their smartphone or tablet. We welcome that the availability of this service has now been extended to 24 hours a day, 7 days a week. Before the coronavirus outbreak, BSL users had reported waiting times of over an hour and we understand that InterpreterNOW had only one interpreter available for NHS111 access at any given time. We understand that NHS111 has now increased the number of interpreters available and is continuing to do so to meet demand.
We understand that the Government is planning to promote these access points on phase two of the Government’s national coronavirus marketing materials.
The Government should provide clarity on the safety and viability of PPE that allows for lip reading in health and social care settings.
The Government and professional bodies should promote awareness of the prevalence of hearing loss in those at risk of becoming severely ill with coronavirus, and simple options for meeting communication needs, amongst health and social care professionals.
BT should provide continuous monitoring of the KPIs for the Relay UK system.
The Government should meet commitments to promote all access options to NHS111 and increase the number of interpreters available via InterpreterNOW.
3. Accessibility of other essential services
We are aware that people in at risk groups, including those for whom shielding is recommended, are struggling to access essentials such as food and medicine. People who are deaf or have hearing loss have told us that they are unable to list themselves as a priority for supermarket deliveries as the only point of contact is the telephone. As the majority of over 70 year olds will have some form of hearing loss, it is essential that other accessible communication channels are provided.
The Government should work with supermarkets and other essential service providers to ensure that people with disabilities are not excluded from accessing essential services.
4. Face coverings and social distancing measures for the general public
The Government is now advising that people should aim to wear a face covering in enclosed spaces where social distancing is not always possible and they come into contact with others that they do not normally meet, for example on public transport or in some shops.
We are aware of a limited supply of face coverings with clear panels, which allow for lip reading, available for purchase in the UK. We are also aware that other such face coverings are in the process of being designed and tested. In the absence of widespread availability of such face coverings, however, some members of the public and employers have chosen to use face shields or make their own face coverings with clear panels at home. There are a number of links available online that demonstrate how to make these. Although we are aware that some such face coverings steam up, preventing lip reading and that others may reduce the sound level of some frequencies in speech, adding an additional challenge for people with hearing loss, people with hearing loss have overwhelmingly reported that such face coverings are more helpful for them in communicating with people than the standard coverings used. Much of the general public, including employers and those working in the community, however, is unaware of the existence or need for such face coverings. It is also unclear whether purchasing and wearing face shields is in line with Government recommendations for public usage and whether this would undermine supply for health and social care settings.
Social distancing itself also presents a communication barrier to people with hearing loss, as the added distance reduces sound levels. People with hearing loss have also reported some members of the public adopting measures, such as avoiding facing people when speaking, which also present challenges for people with hearing loss. In addition, the screens increasingly being used in shops and reception areas can present a further barrier if the needs of people with hearing loss are not considered.
In light of these significant challenges, deaf awareness amongst the public becomes even more vital than ever and many of the tips we suggest for use by health and social care professionals can be adopted by other services. We have also produced tips for use by the general public.
The Government should provide clarity on and improve awareness of the face covering options that are safe and available to make and purchase.
The Government should consider the unintended consequences for disabled people of additional measures put in place when easing the lockdown.
Employers and the general public should be aware of the challenges faced by people with hearing loss and adopt tips to meet communication needs.
5. Audiology services
Hearing aids are a lifeline for so many people, and for some, are the only way they can access sound. As people, especially the over 70s, self-isolate, those who wear hearing aids will increasingly rely on communicating with loved ones over the telephone and receiving the news via the radio or television. So working hearing aids are essential. Hearing aids do need regular basic maintenance and can stop working for a number of reasons but fortunately these can all be easily rectified by an audiologist or trained volunteer and in the majority of cases do not require the patient to be present.
Guidance issued by NHS England and Improvement (NHSEI) sets out how providers of community services can release capacity to support the COVID-19 preparedness and response. This guidance includes a partial stop in the delivery of audiology services for all non-essential treatment until July 2020. Essential hearing aid maintenance and remote appointments, in addition to urgent treatment for idiopathic sudden hearing loss and foreign bodies in the ear canal, for example, should continue to be provided. Further to this, joint guidance from the largest professional bodies in audiology has recently been published, which encourages audiology providers to resume some level of service where possible. The guidance emphasises triaging all patients using remote care and telehealth methods, prioritising patients based on “audiological need”, where their hearing loss is having a negative impact on their quality of life.
Although there is some variation in availability of NHS audiology services, many are still offering appointments remotely, via telephone or video call, and most are providing an essential service for urgent hearing aid repairs or replacement batteries via post. A number of providers have begun to utilise remote programming software, available in a number of NHS hearing aids. Encouragingly, many patients who have been able to receive care remotely have been comfortable using new technology. A number of high street audiology providers are also maintaining a basic service providing appointments remotely, batteries and hearing aid repair via post.
Cochlear Implant Services
The British Cochlear Implant Group has written to NHS Trusts reminding them of the urgency of cochlear implant surgery in specific cases, such as those who are at risk of cochlear ossification as a result of meningitis. In such cases there is a need for surgery in the immediate term before cochlear implantation becomes unviable, so these cases should still be treated as a priority. Further surgical prioritisation guidance has been published by NHS England and Improvement which recognises the need for urgent cochlear implantation, for example in cases post-meningitis and pre-lingual deafness.
Cochlear implant centres and advocacy groups have expressed concern over cochlear implantation surgery within the wider context of surgical prioritisation post Covid-19. There are concerns of a reduction in non-urgent adult implantations as other life-saving operations are prioritised. This is especially concerning when it is estimated that around only 5% of adults in the UK who could benefit from a cochlear implant actually have one. Recent efforts from cochlear implant advocacy groups have been focused on increasing uptake and Covid-19 has the potential to reverse this vital work.
For existing cochlear implant users, or those post-implantation, we are aware that some implant centres have cancelled all appointments and surgeries, only providing urgent repairs. Some implant centres have begun providing remote appointments, including for cochlear implant switch-on and tuning. Encouragingly, many patients have been able to receive care remotely and are comfortable using new technology.
Audiology services should facilitate remote delivery where possible and appropriate, ensuring those who cannot access remote delivery are prioritised when face-to-face services resume.
NHS Trusts should treat specific cases of cochlear implantation surgery as a priority and ensure non-urgent implantation is prioritised as elective surgeries resume.
6. Coronavirus Act
The Coronavirus Act diminishes the duties on Local Authorities in Part 1 of the Care Act 2014 to assess needs for care and support, and to meet those needs. The Act replaces these duties with a power to meet needs for care and support, underpinned by a duty to meet those needs where not to do so would be a breach of an individual’s human rights.
The Government should ensure that the application of new powers under the Coronavirus Act are proportionately delivered and time bound and should provide more clarity on when the emergency powers come into effect.
Local authorities must continue to assess the risks and vulnerabilities affecting individuals.
7. Access to Work
The closure of workplaces has had a major impact on the way people work and for disabled people this will require substantial changes in the support they receive through the Access to Work scheme. For many people with hearing loss, especially BSL users, their existing Access to Work package will no longer meet their needs, either in relation to the type or amount of support they require. For example, somebody with an allocation of in-person BSL interpretation will now need to consider remote interpreting, which might not be provided for in their existing grant.
People will also be concerned that Access to Work will not reimburse them for the cost of support which was cancelled at short notice because of working changes caused by coronavirus.
We welcome the initial indications from the DWP that they are looking at these issues and that further guidance will be provided. We also welcome that a physical signature from a line manager is no longer required to process payments within the scheme.
The Government should ensure that Access to Work offers flexibility to scheme users, in relation to both the support they receive and the way that the scheme is processed. This flexibility should be communicated to scheme users, and their employers, as soon as possible.
8. Loneliness and Isolation
Increased isolation will inevitably affect many people’s well-being and mental health due to a lack of social contact and difficulty accessing support. People who are deaf or have hearing loss are at greater risk of further isolation due to social distancing measures, as well as increased use of masks and face coverings.
Whilst initiatives to tackle social isolation during the pandemic are underway, these initiatives primarily involve moving support online. For BSL users and those with hearing loss this does not necessarily provide the same level of accessibility, especially for older people who might lack the necessary digital skills.
We welcome the Government’s new campaign to tackle loneliness during the coronavirus lockdown. We must remember, however, that the coronavirus pandemic will begin to recede, but unfortunately, loneliness and social isolation will remain for many who are deaf or have hearing loss.
The Government should ensure that loneliness stays high on the agenda through the coronavirus pandemic and beyond.