Dr Rose Balázs tells us about her accessible sexual health clinic in London – and the importance of accessibility in the NHS (BSL)

My name is Rose Balázs. I am a Doctor from South London, I trained in Glasgow and currently work in South West London.

My older sister is profoundly Deaf and I was taught basic BSL when I was a baby/toddler and could sign before I could speak. My parents then focused more on spoken English and so we stopped signing at home.

My sister then picked up BSL again at a Deaf school in her late teens and realised how much more comfortable it was for her to be around signers rather than lip reading.

She asked us all to learn and it took me a long time to get round to it, but eventually after medical school and my first couple of years of training as a junior doctor, I moved back to London and started going to BSL classes.

I was overwhelmed with how much I loved learning BSL, the depth, richness, creativity, humour and discovery of a different part of my brain and personality. I carried on to level 6 which I finished in the summer of 2022.

I recently had the idea to set up a BSL friendly / accessible sexual health clinic.When I was working as a junior doctor in South London, every time I met Deaf patients and used my sign language, even before I was fluent, I realised how rare and helpful it is to be a doctor who can sign.

I knew that I wanted to create a space somehow in the NHS that would allow Deaf people better access to services and raise awareness of existing inequalities.

I spent some time with the National Deaf Mental Health Services when I was doing my psychiatry job at Springfield hospital and was absolutely fascinated by the workings of the service.

When I did my rotation in sexual health, I came across quite a few Deaf patients, and there were a couple of cases with particularly vulnerable people who I felt had received very poor care in the past.

They had been seen previously without interpreters and did not understand the treatments being offered. One young patient had an invasive procedure done by their GP, who did not in my opinion have the capacity to consent to the procedure, and her capacity had clearly not been assessed as no interpreter was present at their appointment – it was quite shocking!

It became clear to me that there was a huge gap in sexual health provision for Deaf people and perhaps there was something I could do about it.

When it comes to BSL users / deaf people in general accessing information about sexual health, there are so many factors.

I think there are low levels of sex education across our society in general, and a lot of people need more awareness of sexual health, this should be starting in schools.

On one hand, I have met Deaf people who are very literate about their sexual health, then there are people who are too embarrassed to go to a sexual health clinic and some who haven’t even heard of or considered the existence of such clinics.

I am aware that Deaf people may be anxious if they were to attend a clinic, that they will arrive at their appointment and not have an interpreter present if they need one. They also may be worried about knowing the interpreter as the Deaf community is so small.

Sexual health is a speciality which really focuses on the whole person and can take people to vulnerable places, which is one of the reasons I find it so rewarding.

Deaf people have the option of seeing me directly without the need for an interpreter. There is evidence that this is something Deaf people want and data to back this up by Damian Brewer who has researched the Deaf community’s access to Sexual health.

I would like to see accessibility across the NHS change for all people who face barriers. I know from the Accessible Information Standard and lots of experience at work and speaking to family/friends, that people who do not speak English as a first language often get worse care in the NHS. I also know that Deaf awareness training amongst NHS staff is very rare.

At our sexual health clinic we offer pretty much everything that any regular sexual health clinic does, from genital problems, sexual infections, vaccinations, sexual health check-ups, contraception, PrEP (pre-exposure prophylaxis, a medicine you can take to prevent the transmission of HIV), psychosexual support and many more things.

The main thing we can’t do is emergencies, as this is a pre-booked clinic. So patients needing care after a recent sexual assault, PEP (post-exposure prophylaxis – a medication you take after a high risk sexual encounter to reduce the risk of contracting HIV), or emergency contraception (a medication taken after unprotected sex to prevent pregnancy), need to seek an emergency appointment at their local sexual health clinic.

I am also not trained to fit coils or implants yet, however can assess and counsel people for these and book them another appointment, making sure their communication needs are met.

At my clinic there are two BSL interpreters present for the whole day. One of them will meet you at reception and take you into a separate room to fill out some brief paperwork. They will then ask if you mind completing a short anonymous questionnaire. Then you will come and see me, you can choose whether or not you wish to have an interpreter present.

Our appointment will involve me asking you what has brought you to the clinic today, I will ask you some questions about your sexual, medical and social history. I will then do any tests (sometimes I will offer you self-tests), examinations or give any treatments that you may require.

We have a pharmacy cupboard on site and can dispense the majority of treatments there and then for free. We even have an onsite lab and often get at least initial results back in under 10 minutes.

At the end of our appointment, I will ask you to complete an anonymous post-clinic questionnaire and arrange any follow up you may need. I may ask if you would like to speak to one of our health advisors (with an interpreter if you need one) for further support.

This may be around sex education needs, questions around healthier/happier sex, sexual infections, chemsex (sex with drugs), previous sexual assault…so many things!

We see anyone aged 13 years and over, from anywhere in the UK. We are based in CLCH NHS trust, opposite Clapham Junction Train station in South West London.

We would prefer to see patients in person as the nature of sexual health often involves tests, examinations or giving medications, however we have done a few virtual appointments which have been well received and we would be happy to consider more in the future if there is a demand for it.

We will see any d/Deaf people who want to use our service. I think I probably haven’t made it clear enough in my communications about the clinic, but you absolutely do not have to be a BSL user to come to the service!

We have one clinic date one Friday per month (no service in December.) Our next dates are on 15th November 2024 and 31st January 2025. We currently have funding until May and then I’m not sure what is going to happen, so watch this space! You can book your appointments online via our website.

We’re currently working on a more accessible system, at the moment the best way is to get in touch via text relay 0333 300 2100.  I man the Instagram and often reply via our DMs but I’m not online daily.

I am very aware as a hearing person that I do not want to try and speak for Deaf people, however I hope I can be a good ally. I hope that the existence of our service might raise awareness of sexual health within the Deaf community.

I would like to see widespread Deaf Awareness training across the whole NHS, I wish BSL training was more accessible to NHS staff (ideally funded) and I wish people had a better awareness in the NHS of how to book BSL interpreters, and that writing back and forth is usually an extremely suboptimal way of communicating with people.

I’d ask any people in the Deaf community reading this, if you feel comfortable, to share information about the clinic with peers. I need as many people to come to the service to demonstrate that there is a need for this in order to secure more funding and spread the word to other services.

I am hopeful it might inspire people all over the country to do something in a similar format. Even if they don’t have a doctor who can sign, just having a service where patients can book and know that they will have a fully accessible experience would be so great.

You can find out more about the clinic here.

The clinic’s Instagram handle is @deafsexualhealthswl