Even before the Covid-19 pandemic, Deaf people who use British Sign Language (BSL) have experienced difficulties in accessing health and social care. However, these difficulties have been accentuated by the lockdown, with organisations moving away from physical interaction primarily to telephone contact. To examine the effects on Deaf people, it is useful to give some historical context.
Historically, Deaf BSL-users have been reliant on specialist social service provision for access to all essential services, including health. This reliance grew out of local charitable societies, whose ‘missionaries’ provided a gateway to the outside world through their understanding of BSL. The Seebohm Report in 1968 (1) led to considerable changes in the provision of social work for Deaf BSL users. Many local authorities (LA’s) absorbed the local charitable societies into their social service departments, while others contracted them to provide services. This started two parallel developments. One initiated a move away from perceiving all Deaf BSL users as social work cases; often all they required was access, which had traditionally been provided by the missionaries in a rather paternalistic manner. The other development was the professionalisation of Sign Language Interpreters (SLIs), which continues with high demand for their input.
Changes in these developments have been gradual. At first, departments and services within a LA would automatically refer all Deaf people to the specialist social service regardless of the main issue, even if that issue was the responsibility of the referrer. However, there has been a growing realisation that all services should be directly accessible to Deaf people. More recently, some authorities have dissolved their specialist social work teams considering that Deaf BSL users should access the mainstream social work services directly.
In 2003 the British Government recognised BSL (2) as a language in its own right. But further legislation has not directly helped to improve services for Deaf people, and the Equality Act (2010) has no mention of BSL, for example. Consequently, LA’s and NHS organisations can still miss opportunities to ensure equitable access to information and services. Many organisations may assume that providing written information is enough to satisfy access, but do not recognise that many Deaf BSL-users struggle with literacy due to a lifetime of not hearing conversations, radio and TV programmes. It is only very recently that access has been accepted as a corporate responsibility, exemplified in the NHS England Accessible Information Standard (2017) (3), also adopted by Wales in 2018. Change continues to be slow.
In response, the British Deaf Association (BDA) created the BSL Charter (4) to encourage LA’s to accept responsibility for ensuring equitable access for Deaf BSL users for all their services. But the number of signatories remains low at 46 out of the possible 774 NHS Trusts, CCGs, and LA’s in England.
The impact of the Covid-19 pandemic appears to have accentuated inequities of access to information and services. Many services now only offer telephone access, leaving the problem of how to navigate this obstacle up to the Deaf person seeking information or services. Online access through websites or email can exclude a majority of Deaf BSL-users. For elderly Deaf BSL-users, or those with additional difficulties such as a learning disability or mental health difficulty, limited experience in using smartphones and the Internet makes online access impractical and often impossible.
Some organisations have attempted to consult local communities, but these are again usually conducted by phone or through online questionnaires. A typical example is a council (name withheld) advertising its Emergency Support Helpline with a telephone number, an online form and an email facility. There was no option for access via an interpreting service or directly in BSL. Promoting awareness of services and consultations is often never done through BSL.
In contrast, the pandemic crisis has elicited strong responses from many specialised third-sector service providers; particularly those run by Deaf people themselves. There have been a number of BSL translations of Government information in the absence of interpreters at some of their briefings. There have also been some local initiatives to ensure that no Deaf BSL-users are adversely affected by changes in local services and amenities.
There have been many examples of Deaf people not communicating with anyone during the weeks of lockdown, particularly those living in rural areas. Those without a smartphone or Internet access have been unable to alert anyone to their predicament. Local networks of Deaf people have taken it upon themselves to visit. Some have produced a “newsletter” in simple English with visuals for older Deaf people who don’t have access to social media. Some have set up a Facebook page called “Stay at Home” with video clips in BSL. Others have visited homes to communicate through windows, or to teach the Deaf person how to use technology. There have been reports of Deaf BSL-users crying with relief after learning how to use video calling on their phone.
The pressure resulting from the pandemic appears to have turned the clock back to pre-Seebohm times, with organisations not fully considering how to implement changes in access that do not exclude members of Deaf communities. There may have been innovative responses by local authorities and health services, but evidence has been hard to find. Recognising this, the British Society for Mental Health and Deafness have issued four guidance documents in both BSL and English: for GPs, for hospitals, for emergency teams, and social care providers. These are being distributed via local Deaf organisations (5).
The most noticeable demonstration of this renewed exclusion and marginalisation of Deaf BSL users is the refusal of the British Government to ensure that its briefings to England are translated into BSL in real time. This omission has been challenged by a “Where’s the Interpreter” campaign on Twitter and a group of Deaf people are aiming to take the Government to court.
The devolved countries have responded differently in their briefings with a SLI visible in their live TV broadcasts. While in Wales there is an implied respect for a minority language, in Scotland, providing an interpreter is partly due to the BSL (Scotland) Act 2015, which requires all Government organisations to develop a plan to show how its services can be accessed in BSL. This has directly led to Scotland having a centralised online interpreting service for all calls not just health-related. In Northern Ireland the Health & Social Care Board have taken on the responsibility to coordinate interpreting services. While in England and Wales the response to provide health information has been taken up not by government but by interpreting agencies in Wales and the third sector in England, such as the creation of BSLHealthAccess.co.uk by the Deaf health charity, Signhealth, in conjunction with an interpreting service, InterpreterNow, using their own reserves to initiate the service.
There has also been a lot of discussion around the use of face-masks which have the obvious effect of obscuring lip-movements and facial expression, both important in both spoken and signed communication. There has been a push for see-through face-masks, but this has come almost entirely from the Deaf community and its activists. According to Action on Hearing Loss, its campaign has led to a Government exemption of using face-masks by Deaf people and people with hearing loss (6). However, this response has been derided because it is the hearing person wearing a mask when talking to a Deaf person who will need to remove their face mask!
All this begs the question, how is it that in one of the richest countries in the world Deaf people continue to be marginalised by government services, particularly in England and Wales, and have to rely on third sector and social care services to provide access?
One recent response has been for some LA’s to promote the use of Direct Payments for Deaf people to pay for access to information and services as form of “communication grant” to buy interpreting support when dealing with mainstream services. However, many LA’s criteria for direct payments focus on care, not communication. Again this raises the question, should all Deaf people be considered in need of “support”, or should services be responsible for equitable access?
Deaf campaigners have called for a BSL Act with specific obligations on organisations within the remit of Government to provide access and ensure the protection of BSL as a language. One aspect that could evolve from such legislative processes would be the development of centralised provision, which would reduce the burden placed on local or small mainstream services and shift the responsibility for access away from the deaf person to organisations themselves.
Additionally, a national legislative framework may also go some way to solve the difficulty of providing support services for the small numbers of Deaf people with additional problems in each geographical area. This can be overcome by working at a regional level. For example, one charity, Action Deafness, provides support to Deaf people covering several LA’s and prevents a ‘post-code lottery’ of access in local areas.
In conclusion, the Covid-19 crisis seems to have taught us that organisations under pressure to change access to their services may repeat past errors in excluding Deaf BSL users. Legislation may be helpful to pressure both local and central government to consider how Deaf people can be provided with equitable access to function at the same level as their hearing counterparts. Not to do so will perpetuate current inequalities, leading to additional stress and reducing the mental health wellbeing for many Deaf people.
Paul Redfern, General Secretary, and Kevin Baker, Trustee, British Society for Mental Health & Deafness