Mark Applin, co-founder of Signly

Mark Applin, co-founder of Signly, highlights the need for an innovative approach when overcoming communication barriers faced by Deaf patients.

“Deaf people’s health is poorer than that of the general population, with probable under-diagnosis and under- treatment of chronic conditions, putting them at risk of preventable ill health.”  

This is a startling revelation but how can it be? Today, when technologists have made huge strides innovating assistive tools to support those with mobility, visual and hidden impairments, how is it that those with limited or no hearing are overlooked in matters as serious as health? Surely, it’s just a case of providing more printed information for these patients? NHS England reveals a simple yet unignorable truth:

“As many BSL (British Sign Language) users have a limited ability to read English, written information may need to be re-presented in BSL, either interpreted face-to-face or offered as a BSL video recording. The cost of producing a document of 600 words as a BSL video file (with a DVD copy and including subtitles) is approximately £300.” 

For many Deaf* patients English is not their first language, so they may struggle with lower literacy and interpreting written information. The consequences?

A matter of life and death

Last year, the South-Eastern Health and Social Care Trust apologised to the family of a deaf man who had to tell him he was dying because a hospital did not provide a sign-language interpreter. He received the news in late 2016 from his daughter, Jillian Shanks. The Trust paid £7,000 compensation to Thomas Carson’s family.

Legislation acknowledges the problem

In response to these issues in England, the NHS introduced the Accessible Information Standard. Those offering care must first assess the communication needs of the patient and provide information and communication in a form that satisfies these needs.

This includes those who are d/Deaf or have some hearing loss. The legislation is a great basis on which to build a better ecosystem and yet, the practicalities of implementing even the spirit of the standard are both challenging and profound. 

For one thing the UK has a shortage of sign language interpreters. A Comprehensive Guide to Sign Language Interpreting in Europe estimates the ratio to be in the region of one interpreter to every 70 deaf sign language users. And in financial terms, agency fees for two interpreters hired for an hour meeting costs up to £300, not including travelling costs and admin fees.

You can see in this one area alone that there’s much to be done to improve the complete patient experience; beginning with contacting the GP surgery, to accessing pharmacies and hospital consultations, as well as post-operatively in order to enhance the good work of interpreters and video relay providers. But where does one start?

A time for tech?

Interestingly, the Access to Health Services for Deaf People conference in 2015 stated “Health care providers need to make better use of technology to improve access for deaf patients.” The creation of sign language avatars might seem to the hearing world to be the panacea to the issues mentioned above. 

The World Federation of the Deaf and WASLI, however, raises a counter argument in its discussion on the Use of Signing Avatars: 

“Whilst the technology has progressed and offers real potential for wider use of signing avatars, these computerised products do not surpass the natural quality and skill provided by appropriately trained and qualified interpreters and translators. Individuals who are fluent in a signed language and qualified to present information on particular subjects not only use the hands, arms, shoulders and torso, movements of the head, facial expression and mouth patterns, but also include cultural information where necessary to convey the intended meaning contained within a message.”

In other words, these computer-generated translators are nowhere near as effective as the real thing! It’s a little like using Google Translate. It’s a great tool which we all make use of from time to time, but how many of us would like to rely on it in a medical crisis? 

Research identifies the gaps

To learn more, we visited three teaching hospitals in the UK - each cited common gaps and lack of BSL content in the following areas:

  • Post-operative information packs
  • Discharge instructions
  • Medicine directions
  • Emergency Department advisory sheets
  • Wider community public health advice, including diabetes, cancer, heart disease and dementia. 

Currently there appears to be a lack of enterprise level tools to support the desire to provide this basic need for information. An innovation is needed. Signly has already experimented with using real interpreters to pre-record sign language content and digitally ‘attach’ it to leaflets and posters to augment the written word. 

If patients could receive printed information in sign language, served up via augmented reality, the natural step would be to ‘sign language enable’ hospital websites. Our experience in trying to test concepts like this in the health sector has yielded little in the way of immediate action and remains one of the hardest sectors in which to realise these objectives. 

Our challenge as a collective is to think deeply on how to build innovative solutions and embed them to achieve meaningful change.

We have the technology. We can deliver. We just need a little help to realise the ambition.

*Deaf people may consider themselves either Deaf (with a capital D) or deaf (with a little d). While these terms do not fully explain the full spectrum of attitudes, conformities, or life experiences, they can help us to understand how identity differs in deaf culture.

Deaf Action describes the key differences as:

Big D deaf people are those who are born deaf or experience hearing loss before spoken language is acquired and regard their deafness as part of their identity and culture rather than as a disability. They form the Deaf Community and are predominantly British Sign Language (BSL) users.

Small d deaf people are those who have become deafened or hard of hearing in later life, after they have acquired a spoken language and so identify themselves with the hearing community. Small d deaf people are more likely to use hearing aids and develop lip-reading skills.