Helen Cherry: A Case for Remote Captioning in the NHS

Poor Communication Hitting the Headlines

“Careless”, “insincere” and “unclear” communication has fuelled a surge in complaints against the NHS in England claimed a a recent BBC headline (http://www.bbc.co.uk/news/health-20254108).

As a bilateral hearing aid wearer since childhood and an NHS professional for over 20 years, I am the first to say this is sadly very much a problem, and at times I feel a lone voice amongst my NHS peers. Poor communication with colleagues remains a daily bugbear.

I am 53 and have seen great advances with the development of hearing aids and communication devices. Add to that subtitling so I can access the cinemas and theatres, and you would think that such advancement would filter out to the essential area of clear communication within the NHS. You might think there would be an understanding that clear communication could reduce costs because it would reduce problems that occur because of poor communication.

Some Scary Statistics

Looking back at some old RNID stats from 2004 (now Action on Hearing Loss) following a survey for their report ‘A Simple Cure’ (http://www.med.qub.ac.uk/DeafAwareHealth/files/asimplecure.pdf ) the statistics are startling:

24% of deaf or hearing impaired people miss appointments

19% miss more than five appointments because of poor communication (such as not being able to hear their name being called) — costing £20 million to NHS per year.

35% of deaf and hard of hearing people had experienced difficulty communicating with their GP or nurse

Sensible examples of improvements were suggested such as using remote BSL interpreting, better written information in plain English, making appointments by email or text and encouraging staff to look at how they communicate.

Action on Hearing Loss’ 2011 members’ survey (http://www.actiononhearingloss.org.uk/supporting-you/policy-research-and-influencing/research/annual-survey-of-members/annual-survey-2011.aspx ) included a set of questions about contacting and visiting the GP surgery. Over one-third of the respondents 38% felt they had missed important information when visiting their GP.

My Own Experience

From my own experience since this report there have been some improvements, such as the ability to make bookings on line and appointment reminders via text. However, when attending hospital appointments, as recently as 2 weeks ago, even though I highlighted very clearly that I am hard of hearing, have difficulty hearing my name called and so could staff please come and get me — well you guessed it – I nearly missed my appointment because I didn’t hear my name called on 2 occasions.

When, after half an hour, I approached to ask how much longer my appointment was running behind time, I was reprimanded for not ‘being there’ when my name had been called and had I popped out or been in toilet?! I won’t bore you here with my response to correct them, as I am sure many have had the same frustrating experience. So sadly things still haven’t changed and it is of no wonder that complaints about communication remain so high.

Worrying feedback about BSL interpreters within the NHS

Earlier this year a survey of BSL users’ experiences of accessing communication support in a healthcare setting came back with some worrying results:

• 48% of respondents have been unhappy with the standard of sign language interpreter provided;
• 41% of respondents have left a health appointment feeling confused about their medical condition, because they couldn’t understand the sign language interpreter;
• 29% of respondents have been confused about how to take their medication, because they couldn’t understand the sign language interpreter.

All the above outcomes suggest that Deaf people are not always being provided with registered, fully qualified, interpreters.* These statistics provide evidence for a much needed wake up call for all health providers on communication. We must not become complacent by thinking that providing BSL interpreters is the be all and end all, as clearly it is not.

A Way Forward

So why am I writing all this? I want to highlight and advocate a way forward on communication. I want to ensure that information is both recorded and understood. I want to campaign for patients to have access to services like Remote Captioning.

I am focusing on Remote Captioning because it has the advantage of being in real-time word for word what is being said by the health-practitioner during a consultation, but it can also be printed off at the end of the session and read again if there is something was unclear. It is also cost effective, flexible and available.

I have just found out about this service myself after all these years of managing without any special equipment. I even thought that Access to Work (https://www.gov.uk/access-to-work/overview ) meant helping people who were not in work get into work, and so not relevant to me!

Why Remote Captioning?

I am writing this having had my own recent personal experience using Remote Captioning in my work meetings, which came about following a fluke introduction to a Palantypist working for Bee Communications (http://www.bee-communications.com/remote-captioning.htm). This led me to meet with Beth Abbott and learn more about her organisation and how Remote Captioning works.

What a breath of fresh air to spend time with Beth, totally energised and committed to everyone having access to this service. A joy to meet with and spend time with someone who has such understanding of the differing needs of people with all forms of hearing loss and the benefits of how Remote Captioning could fit into an interpreting service.

Naturally I have begun to raise this with my own health organisation, and of course the first response is costs. Yes, there are savings to be made in the NHS but I think if we have not moved on very much from the statistics I quoted at the beginning, with £20 million of costs to NHS per year because of poor communication, then the bigger picture is obvious isn’t it?!

For those who would like the option of Remote Captioning when they attend an appointment this has got to be something we strongly advocate as a better option. When the ‘slogan’ for NHS is ‘No Decision about me without me’ we should be focusing on enabling patients to make informed decisions with clear information.

No More Excuses

As for me it is fantastic to discover I was eligible for an Access to Work budget and with this fund I now book a Remote Captioning for meetings and forums. I can now participate actively and confidently, as well as having a record of what has been said which I can refer to.

And my favourite thing? No more patronising responses when I question something said at a later date. No more people trying to wriggle out with their usual response “oh no that’s not what I said, you couldn’t have heard me”… I might not have heard you fully but my Palantypist did and it’s all in writing!

The full findings of this survey can be found here: http://www.actiononhearingloss.org.uk/get-involved/campaign/equal-treatment/the-problem/survey-of-bsl-users.aspx.

Helen Cherry works for the NHS.

The Limping Chicken is supported by Deaf media company Remark!, provider of sign language services Deaf Umbrella, and the RAD Deaf Law Centre.