Meeting of needs
Services must provide one or more communication or contact methods which are accessible to and useable by the patient, service user, carer or parent. The method(s) must enable the individual to contact the service, and staff must use this method to contact the individual. Examples of accessible communication / contact methods include email, text message, telephone and text relay.
Appropriate action must be taken to enable patients, service users, carers and parents to communicate, including through staff modifying their behaviour and / or supporting the use of aids or tools. This includes provision of communication support for individuals accessing both outpatient and inpatient services, including long-term care, and those in receipt of publicly-funded social and / or NHS care whilst resident in a nursing or care home.
Service providers are responsible for making necessary adjustments at their own cost; not at the cost of the disabled person. Guidance from the Equality and Human Rights Commission states: “If an adjustment is reasonable, the person or organisation providing it must pay for it. Even if a disabled person has asked for an adjustment, he/she should not be asked to pay for it.”
In cases of GP appointments it needs to be decided locally who will fund, but if the appointment is for health reasons then it should be health that funds it rather than social care.
The CQC states
In the Equality Act 2010 there are additional requirements to make reasonable adjustments for disabled people. This means that interpreting and providing written information in alternative formats such as large print on request are likely to be legal requirements for GP practices. Practices can consider the ‘reasonability’ of each case.
Specific contact method
Service providers must ensure the service user’s communication needs are flagged. For example, some service users with a hearing loss will not be able to telephone. Alternative accessible communication/contact methods can include emails and text messages.
Specific information format
Organisations must ensure that the need for information in an alternative format is flagged and either triggers the automatic generation of correspondence in an alternative format (preferred), or prompts staff to make alternative arrangements. A standard print letter MUST NOT be sent to an individual who is unable to read or understand it.
We do not advise you hold large stocks of patient materials available in multiple alternative formats as information will date and resources could be wasted. It is more cost effective to have documents saved in Word formats which can be quickly and easily altered to suit the patient and then printed or emailed. A small maintained stock of key documents in Braille, DVD etc should suffice.
Use of ‘large print’
Recording information in ‘large print’: codes must specify font sizes and types to be used. Point sizes other than ‘standard’ (10 or 12 point) need to be specified – for example, point size 16 is required.
‘Sans serif’ fonts are easier to read for most people with visual loss and for people with learning disabilities. A ‘sans serif’ font is without the small projecting features called ‘serifs’ at the end of strokes. A well-known example of a ‘sans serif’ font is Arial.
Use of communication professionals
Where a professional interpreter is needed, the person must be skilled, experienced and qualified. The service provider must verify accreditation, qualification and registration with a relevant professional body. This is relevant for the use of British Sign Language (BSL) interpreters and deafblind manual interpreters, who must have:
- Appropriate qualifications
- Disclosure and Barring Service (DBS) clearance
- Agreement to work to a professional code of conduct
- Assurances of these requirements should be obtained by the service provider
A deafblind person may receive individual support from an identified professional to support them in communicating, such as a Deafblind communicator-guide or Deafblind intervenor. If so, it would be expected that this person would accompany the deafblind person.
Use of health and social care staff as communicators/interpreters
If health and social care staff are qualified, experienced and registered as British Sign Language (BSL) interpreters, they could work in this capacity, but only with the service user’s consent. This consent must be recorded. Providing an independent communication professional should always be offered.
Use of family members, friends or carers as interpreters
AIS aims to support individuals’ rights to autonomy and their ability to access health and social care services independently. In all instances, the individual patient, service user, carer or parent must be offered professional communication support where they have an identified need for communication using British Sign Language, deafblind manual or other alternative communication system.
Where an individual has sensory loss (hearing loss and / or visual loss) and no other impairment, a professional interpreter / communication professional must be used unless there is documented, supported evidence of the individual’s explicit preference for the use of a family member / friend / carer. The parameters in which the individual’s family member / friend / carer is to be used must be agreed with the individual and recorded as part of their record or notes.
Access to appropriate, and suitably skilled / qualified / knowledgeable support, from a communication professional provides assurances that important information is interpreted accurately, which is essential for safe, effective care. However, there is a need for flexibility to respond to individuals’ needs and preferences. Such flexibility is most likely to be appropriate where ‘bespoke’ / highly personalised communication approaches are used by individuals and their families / friends / carers, especially where they have complex needs.
Requests for the use of specific professionals
Wherever possible, requests from individuals for a male or female communication professional, for a particular professional and / or for the same professional to provide support to an individual during a course of treatment, should be met. Good practice would suggest that particular efforts should be made to accommodate requests for individual, consistent and / or male / female communication professionals where an individual is undergoing particularly invasive, intensive or sensitive procedures / courses of treatment, including care relating to pregnancy, maternity or sexual health, radio- and chemo-therapy, end of life care and when accessing mental health services. Such preferences should be clearly and objectively recorded in a free text area of an individual’s notes or record. Organisations should also consider the use of interpreters with additional skills, knowledge or experience in relevant terminologies and / or care settings.
Remote access to communication support
In addition to the ‘traditional’ approach of arranging for a particular communication professional to attend an appointment, video relay services / video remote interpreting can now be accessed. The technology can be accessed via a smartphone, tablet or computer, enabling quick and easy access to communication support for d/Deaf people.
Video interpreting services are particularly useful in urgent or emergency care settings, when it may not be possible to arrange for face-to-face support from a communication professional in time. They should not be seen as a total replacement for face-to-face interpretation / communication support, and may not be appropriate in some circumstances, especially for longer appointments. Best practice would be that, where possible, and for routine care, individuals should be given the option of remote or face-to-face interpretation.
Key word signing including Makaton
Communication using a key word signing system, such as Makaton, is included within the scope of the Accessible Information Standard. This includes ‘translation’ of information using Makaton or another key word signing system (as part of the ‘specific information format’ category), use of Makaton or another key word signing system as a type of ‘communication support’, and requiring a Makaton or other key word signer as a ‘communication professional’.
This relates to the provision of support to enable effective communication / conversation, for example by the provision or use of aids or equipment, or by health or social care staff making adjustments to their behaviour. Staff may need training or other awareness-raising in order to effectively provide some of the types of support / adjustments indicated.
Perhaps the most commonly used additional aids to communication are lipreading and hearing aids – often used by individuals in combination – and easily supported by provision of a (working) hearing loop and ensuring that the lip-reader has a clear line of sight to the speaker’s lips and face.
Requests from individuals with communication needs / requiring support to communicate to be seen by one or more particular members of staff should be accommodated wherever possible. Familiarity with the nuances of a staff member, clinician or professional’s dialect, accent and manner of speaking can assist an individual with a disability, impairment or sensory loss to communicate effectively.
The scope of the Standard includes accommodation of an individual’s need or requirement for a longer appointment to enable effective communication / the accessible provision of information. Applicable organisations should ensure that systems and processes for scheduling and managing appointments enable this flexibility. In particular, any appointment requiring support from a communication professional will almost invariably take longer – because of the ‘three-way’ nature of the conversation – and allowance for this should be made.
Commissioners should ensure that they support this requirement including through tariffs, contracts and performance-management frameworks with provider organisations.