Hearing loss and GPs – missed appointments and misunderstandings

The health service is there to help people stay well and, when they are not, to help them cure or manage any condition they have.

As a statement, that could hardly seem more redundant.

However, unfortunately it is worth restating – because some people are not being catered for suitably, specifically those with hearing loss.

A report released last month by Action on Hearing Loss NI highlights how some shortcomings in provision are staggeringly basic.

Good Practice? looks at the difficulties those with hearing loss have accessing and using services offered by GPs. Some of the findings are shocking:

• Nearly two-thirds (68%) of respondents say they feel unclear about what they've been told by their GP, at least some of the time.
• 41% say doctors or nurses speak too quickly and 47% say the doctor or nurse doesn't check that they've understood what's been said.
• Over one-third (35%) say they ask other people to call their GP surgery on their behalf, but less than one fifth (18%), want other people to do this.
• Almost half – 45% - said they had faced difficulties booking a same-day, urgent appointment in the past year (representing two thirds of those who had tried to do this in those 12 months).
• Of those who experienced difficulties, 48% said this was because this was because urgent appointments can only be booked over the phone, and 39% said they had to ask a family member or support worker to call on their behalf.
• Only 4% say a hearing loop system is available at their GP surgery reception.

These findings are not in isolation. There is a trend.

Scope previously wrote about how Action on Hearing Loss in England found that 28% of people with hearing loss had left their GP unclear about a diagnosis and 19% unclear about medication – results that emerged in a previous report from England.

Access All Areas (2013) found further that 14% had missed their appointment altogether because they had not heard their name called out in the waiting room.

These observations mirror the barriers encountered by people with sight loss, with the RNIB in NI previously reporting that 72% of blind or partially sighted people are unable to read personal health materials sent them by health professionals and 22% had, as a result of this missed appointments.

The madness of the situation is that both hearing loss and sight loss are intrinsic concerns of the health service. The lack of anticipation that people with either or both of these conditions might need to access fundamental services is a failure.

Detail

Action on Hearing Loss NI says almost 300,000 people have hearing loss in Northern Ireland – one in six of the population – and, due to ageing demographics, by 2034 that figure is set to rise to 400,000, around one-fifth of the expected population.

Of those 300,000, around 5,000 people use British or Irish Sign Language (BSL/ISL) as a first or preferred language.

Between September and December last year, the organisation carried out a survey in NI (as well as England and Wales) to explore the experiences of people with hearing loss when accessing GP services. There were 100 local respondents (out of a total of 1,411 in the UK).

As well as some of the more headline-grabbing issues listed above, there are more mundane – but nonetheless impactful - difficulties when it comes to simply organising appointments.

Broadly speaking, respondents want to be independent and would like methods of access that would allow this.

The report said that, in terms of booking appointments to see their GP, the “findings suggest that many people would prefer not to have to visit their GP practice in person, use the telephone or rely on family and friends to make appointments on their behalf. Their preference is to use SMS, email or online booking systems.”

However, it is not necessarily the case that digital or text-based options are widely available at local surgeries.

For instance, 90% of respondents said their GP does not offer text/SMS reminders about appointments – whereas in England 53% said they already receive this service.

Furthermore, when it comes to repeat prescriptions, per the report:

Almost half (47%) of survey respondents said they order repeat prescriptions online, but only 6% can get test results in this way – suggesting there are substantial variations in terms of the scope of online GP services offered to patients.

A high proportion of survey respondents didn’t know if they could use online services to order repeat prescriptions or get test results:

• Almost one-quarter (22%) of survey respondents didn’t know if they could order repeat prescriptions online.

• Over a third (36%) didn’t know if they could use online GP services to get test results.

Almost one-quarter (22%) didn’t know if they could order repeat prescriptions by email, rising to 38% who didn’t know if email access was available for getting test results. Over half, however, also said email access is unavailable for these services.

Knock-on concerns and recommendations

Hearing loss can lead to further problems. Per the new report, left unaddressed hearing loss can lead to feelings of loneliness, emotional distress and withdrawal from social situations, while people with hearing loss have increased risk of depression and dementia.

Older people who are deaf or have hearing loss are also likely to have other age-related conditions such as sight loss or cancer; diagnosing and managing hearing loss is crucial for good communication and care.

These are not new issues. A 2010 report - Is It My Turn Yet? - found that many GP practices needed to give their staff training in sensory disability, and to invest in equipment such as hearing loops. It also established that providers wanted to improve their accessibility.

Working together with the RNIB, the charity produced a guide for GP practices on how to improve accessibility that was distributed by the Health and Social Care Board in 2014.

However, this latest research found that the majority of patients are not asked about their communications needs – only 9% said they were offered support and asked if they understand what is said in appointments - and have noticed no improvements since this advice was sent to all GP surgeries.

When asked what changes they want to see, 36% said their chief priority is having more accessible ways to contact their GP (such as email and SMS), while 37% also put improving online access in their top three requests.

Action on Hearing Loss NI says: “We are calling on the Department of Health to introduce an Accessible Information Standard to Northern Ireland. It needs to ensure a consistent and specific approach to identifying, recording, flagging and sharing accessible information needs, to be supported by independent monitoring mechanisms.

“GP and NHS services must make sure that services are accessible to people who are deaf or have hearing loss. This includes increasing the use of SMS and online access to services. Staff working in health services should get high quality deaf awareness training.”

For any public service to be of use it has to be accessible. For the health service to have in-built obstacles in the way of people with particular health conditions is really not acceptable.