NHS in Scotland not listening to deaf and hearing impaired people

When you call the NHS, you expect and believe that the service you get over the phone will be the same as if you were there in person.  The same high standards will apply.

That is fine if your hearing is good enough to hear what the person on the other end is saying and asking.  If you are one of the hundreds of thousands of deaf and hearing impaired people [not using BSL] who struggle with telephone based conversations, the NHS in Scotland struggles to offer you the same quality of service which hearing people get when they phone the NHS

In 2019 Scotland's NHS Boards were asked to provide data on all telephone calls received over the last 3 full financial years, with the telephone being the most common method of contacting the wide range of services provided by the NHS.  From that baseline data, Boards were then invited to release data which showed how they were quality assuring telephone calls to them made by deaf and hearing impaired people not using BSL and where the contact would most likely be made via Minicom or Next Generation Text Relay.

The questions were focused to reveal what quality assurance systems were in place in each Board to check the accuracy of the call enabled and the accuracy of medical advice offered in such calls.   Boards were also asked what systems were in place for regular sampling of these calls to gauge user satisfaction and to reveal what levels of satisfaction were being reached.  To provide a wider context to the study, Boards were also asked to provide similar data sets for people contacting them by phone and for whom English was not their first language and who would need communication support in the shape of Language Line or Big Word interpreting services.

On the basis of the data supplied by the minority of NHS Boards in Scotland, incoming calls to NHS Scotland exceeded 52,100,000 over the last three calendar years.  Given the number of Boards unable to find and supply the data, the true figure is likely to be well in excess of that total.  On a daily basis, 9 of the 22 NHS Boards in Scotland are receiving, on average, 47,600+ telephone calls per day.  The other 13 NHS Boards in Scotland don’t know how many calls they are receiving each day.

We are now well established in the 21^st century and yet large parts of the NHS in Scotland are unable to access and assemble basic data on telephone traffic which should be an essential and key feature of the strategic management of service development today and well into the future.  If this data gap were revealed to be the case with a large private sector organisation such as British Airways or Marks and Spencer, the share price would plummet as a direct result.

In 2018, the average daily calls in to the NHS across all of Scotland by people using language interpreting support was 41 calls per day – when the average daily rate of all incoming calls to NHS Boards was over 47,700 per day.    

While evidence of equality of access to the NHS for people whose first language is not English is limited to just a few parts of the NHS, evidence on equality of access to the NHS for deaf and hearing impaired people not using British Sign Language [BSL] is even more difficult to find.  Just two of Scotland’s 22 NHS Boards [NHS24 and NHS Fife] revealed details of the volume of calls received and enabled by such as Minicom, Next Generation Text Relay or other systems.  According to the data supplied by all Boards it is revealed that the number of calls made to the NHS across Scotland by deaf or hearing impaired people and enabled by Minicom, NGTR or similar averaged 1 per week.  This compares to the total incoming calls across NHS Scotland of an average of over 47,600 calls per day.  

When it came to quality assurance of the calls, and from the responses received from the 5 Boards who had logged the over 43,000 calls received over 3 years and enabled via Language Line or similar, it was revealed that not one of the 43,000+ calls was selected for audit and quality assured for accuracy of content or of the medical advice offered.

Given just 2 of the 22 NHS Boards in Scotland [NHS 24 and NHS Fife] have been gathering data on calls received from deaf or hearing impaired people using Minicom, NGTR or similar, it was not expected that much data on quality assurance would be available.  The response from both NHS 24 and NHS Fife to this particular part of the FoI was to indicate that none of the calls received via Minicom, NGTR or similar had been quality assured, either for accuracy of the call content or for the accuracy of the medical advice offered in the call.

In the last 3 complete calendar years, Scotland’s 22 NHS Boards received well in excess of 52,188,408 telephones calls [just 9 of the 22 NHS Boards provided call data – the rest not gathering or unable to gather the data].  Of the 52+ million calls received by the NHS in Scotland over the last 3 years, just 43,162 [0.09%] calls were received from people whose first language is not English and were enabled by Language Line or similar.  Calls from people who are deaf or hearing impaired and not using BSL and enabled by NGTR or similar totalled 181 [0.0004%].

NHS Boards reported that none of the calls made possible via the different forms of communication support are routinely subject to audit by them for quality assurance purposes in relation to the accuracy of call content or accuracy of the medical advice offered.  Similarly, none of the calls were subject to user satisfaction surveys on experiences of accessing and using health services by phone.

Given the Equality Act 2010 places a clear duty on NHS Boards to provide health services free of discrimination, the realities revealed by this research note suggest that NHS Boards in Scotland are unable to offer robust evidence that equality of access to health services by phone is being delivered for people with different communication support needs.