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      Coronavirus policy statement

      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.

      Published: 24 March 2020

      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 either:

      Ayla Ozmen, Head of Research and Policy
      Email ayla.ozmen@hearingloss.org.uk
      Call 07787 538267

      Rob Geaney, Head of Public Affairs and Campaigns
      Email robert.geaney@hearingloss.org.uk
      Call 07709 357786

      1. Accessibility of public health information

      We welcome that the majority of audio public health messaging currently available is subtitled. A large proportion of current public health messaging remains inaccessible to British Sign Language (BSL) users however. For many of those whose first language is BSL, reading written English can be difficult. Critical information on the GOV.UK website regarding coronavirus is not being translated into BSL.

      SignHealth, the Deaf health charity, has produced BSL versions of some public health information, though this hasn’t been promoted by the government and public heath messaging will continue to evolve rapidly with no plans for BSL translation. We welcome the government's recent publication of short BSL videos including basic public health information, however, the content of the videos is extremely limited, including basic guidance to wash your hands, for example.

      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. The government’s decision to work with broadcasters to provide BSL interpretation for the daily press conferences is therefore a welcome step that should continue. There was, however, unfortunately no BSL interpretation for the announcement that took place at a slightly later time on 23 March. With such critical information being delivered by the Prime Minister during this announcement, it is vital that the BSL community have access to this. 

      Recommendation

      The government should provide and publicise comprehensive, timely public health information in BSL and make sure BSL interpretation is provided for all daily televised coronavirus briefings and announcements.

      2. Accessibility of health services

      Remote appointments

      People are increasingly 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.

      The Accessible Information Standard (AIS) puts a legal requirement on all health and social care providers to meet the communication needs of people who are deaf or have hearing loss. This includes identifying, recording and meeting people’s specific communication needs, many of which will have, until now, been met by face to face contact. The communication preferences of many will change in the current context, however, and it may become difficult to meet the needs of others, who require face to face communication, without putting public health at risk.

      Our research 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 people whose communication needs have not been identified will also struggle to communicate remotely.

      In these exceptional circumstances, there are simple options that, although sub-optimal in usual times, will improve accessibility of services for those who are deaf or have hearing loss. These include:

      • adopting simple communication tips to ensure understanding in telephone conversations
      • using screens where possible
      • utilising Video Relay Service
      • allowing friends and family to speak on behalf of patients, if requested.

      View more communication tips for healthcare professionals.

      BSL interpreters

      There is already a shortage of BSL interpreters across the UK. In a recent Action on Hearing Loss survey, more than half (57%) of people who are deaf said they felt unclear about their health advice because a sign language interpreter was unavailable for their appointment.

      More recently, we have had reports of interpreters being asked to self-isolate as they have been working in hospitals or GP surgeries where cases of coronavirus have been found. This problem is likely to escalate and so access to interpreters will become even more restricted.

      Furthermore, the government guidance on who falls into the ‘key worker’ category does not explicitly include communication support workers, including interpreters. 

      Text Relay

      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 people now unable to access services or make appointments in person, this service will be experiencing a substantial increase in demand. 

      NHS111

      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 – that is, 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. This service can be used at any time, though is not currently being widely promoted.

      BSL users can also access the NHS 111 BSL Service 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.

      Recommendations 

      • 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, among health professionals.
      • Schools and nurseries should recognise communication support workers who cover critical public services as key workers.
      • BT should provide continuous monitoring of the KPIs for the Relay UK system and, if necessary, consider what steps it can take to ensure that calls to health providers continue to meet the targets required.
      • The government should meet commitments to promote all access options to NHS111 and increase the number of interpreters available via InterpreterNow.

      3. Audiology services

      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 stopping the delivery of audiology services, aside from urgent treatment, for example for idiopathic sudden hearing loss and foreign bodies in the ear canal, and the provision of or referral for microsuction and specialist batteries.

      We welcome these exclusions, particularly highlighting the need for urgent treatment in some cases, but believe, even in the current context, audiology can and should continue providing a service that goes beyond these minimal exclusions while still maintaining social distancing and with very limited staffing. 

      Currently there is variation in availability of audiology services across the country: some departments are still offering a comprehensive audiology service, some are offering certain appointments remotely, and others have cancelled all clinics and are only providing an essential service for urgent hearing aid repairs or replacement batteries via post. Most audiology providers on the high street are maintaining a basic service including remote appointments, batteries and hearing aid repair.

      Hearing aids are a lifeline for so many people, and for some, are the only way they can access sound. As more people, especially the over 70s, are being encouraged to 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.

      Hearing aid batteries need replacing every 5 days to 2 weeks – depending on the type of hearing aid. Most audiology services already have a system in place for patients to receive batteries by post. 

      The British Academy of Audiology has made recommendations on the type of paired back service that could be provided in the current context.

      While we think that in many cases it remains possible for services to continue offering a basic service, beyond the critical services highlighted by NHSEI, we understand that some services will be unable to continue to provide such a service. In light of this, Action on Hearing Loss is currently monitoring the support still available and will explore what service we can deliver through our information line; remotely through our local services; and in partnership with others, to provide information, batteries and hearing aid repairs. 

      Cochlear implant services

      In order to free up capacity and beds, the NHS is cancelling all routine surgery, which includes cochlear implantation surgery. 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 should still be treated as a priority.

      We are aware that some implant centres have cancelled all appointments and surgeries, only providing urgent repairs for existing patients. 

      Recommendations

      • Audiology services should continue providing patients remote appointments, as well as batteries and hearing aid repair by post or via a friend or relative, wherever possible. Where this is not possible, providers should contact Action on Hearing Loss.
      • NHS Trusts should treat specific cases of cochlear implantation surgery as a priority.

      4. Coronavirus Bill

      The government has published its emergency legislation, the Coronavirus Bill. The Bill is expected to become law on Thursday 26 March. Clause 13 of the Bill removes existing regulations which delay a patient’s discharge from hospital – it removes the need for a NHS Continuing Healthcare Assessment and provides simpler procedures to transfer a patient from Acute to Social care.

      The Bill also 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 Bill will replace 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. 

      As it is currently only those with the highest levels of need who receive care and support however, it cannot be right to leave this group of people without the right to assessment and support.

      Recommendation

      Provisions in the Bill must be revised to ensure rights to assessments, care plans and rehabilitation for those with the highest levels of need are maintained. 

      5. Loneliness and isolation

      Increased isolation will inevitably affect many people’s wellbeing 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 stricter social distancing measures. 

      BSL users whose preferred method of communication is face to face, will be particularly impacted. 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. 

      The coronavirus pandemic will peak and begin to recede, but unfortunately, loneliness and social isolation will remain for many who are deaf or have hearing loss. Further research is needed to tackle this issue long term. 

      Recommendation

      The government should ensure that loneliness stays high on the agenda through the coronavirus pandemic and beyond.