The admission of a patient with sensory impairment to a ward within our trust highlighted a gap in our service (Box 1). This paper describes how a group of committed staff addressed this issue.
As a result Plymouth Primary Care NHS Trust now has a policy and protocol in place on the care of sensory impaired patients, an ongoing training programme for clinical and non-clinical staff, an information pack available to all staff and GPs, an active steering group ensuring that these developments are monitored and evaluated and that the service provided continues to be enhanced.
Investigation into this subject identified that there were legal requirements which supported our desire to improve provision for patients within the trust.
The Disability Discrimination Act makes treating disabled people less favourably than other people, without justification, unlawful in areas such as buying goods, using services, finding somewhere to live and getting a job (Department for Education and Employment, 2000).
It also became apparent that as a trust we probably have a high number of potential patients with some kind of sensory impairment because we have many older patients.
The goal of this project was simply: 'To meet the needs of patients with sensory impairment in line with the Disability Discrimination Act and equal opportunities policy.'
This process would always begin with the assessment of all patients for sight, hearing and speech impairments (Figure 1).
To guide the service development we set out a list of specific objectives. These were that patients with sensory impairment will:
- Receive equal opportunity to access the services and resources provided
- Have equal opportunity to participate fully in their care
- Have equal access to confidential treatment
- Have equal access to relevant information to be able to consent or make an informed choice about treatment.
These goals would provide benefits for both the patients, who do not get equal access to services, and the trust, because it would now be meeting the requirements of the Disability Discrimination Act.
Staff would also benefit by being better informed, and therefore better able to help individual patients.
A variety of agencies was contacted to find out if they had any policies/procedures that could be used or adapted.
This type of provision is sadly lacking across the country and other trusts. Agencies/organisations contacted included the Royal National Institute of the Blind, the Royal National Institute for Deaf People, Plymouth City Council (PCC) Sensory Team, the Hearing and Sight Centre, the Disability Information and Advice Centre (DIAC), National Deaf Mental Health Services (Birmingham), a local British sign language interpreter, Plymouth Primary Care NHS Trust Human Resource Department and the disability adviser for Cornwall.
We accessed a number of documents through these organisations that provided useful guidance (DoH, 1997, 1999, 2000a, 2000b; RNIB, 1995a, 1995b; RNID, 2000; RCP, 1998).
Using these documents and our own experience, a protocol was drawn up in the form of a flow chart identifying issues to consider when someone with a recognised hearing, sight or speech impairment is admitted to the ward (Figure 1).
Staff were advised of the plans and progress through the local staff bulletin.
Important action points
This process highlighted several action points:
- The need to train all staff in the implications of sensory impairment
- Staff need to understand what sensory impairment is and the issues related to working with patients with special needs such as mental health or learning disability as well as sensory impairment
- Staff also need to be aware of which resources are available and how to access and use them, including Type Talk and Minicom. Type Talk is a national telephone relay service that enables deaf, deaf/blind, deafened, hard of hearing and speech impaired people to communicate with hearing people anywhere in the world via an operator. A Minicom is a text telephone which links directly to another text telephone
- To make information easily accessible to visually impaired patients and in a suitable format, such as Braille or large print. This includes Mental Health Act information, ward information and drug labels
- To make a variety of aids available within the primary care trust, for example Audioport (a personal sound amplifier) or Infraport (a TV listening device), an infrared receiver or similar as recommended by specialist organisations
- To roll out a hearing and sight volunteer programme currently being piloted across several elderly care wards in the trust and to provide funding from Plymouth Primary Care NHS Trust. This programme involves a volunteer from the Hearing and Sight Centre visiting the wards to give advice and support on the management of hearing aids to both patients and staff
- A longer-term action point was to ensure that funding is set aside within the trust for the use of sign language interpreters and other resources when required
- Future decorating and building work within the trust should consider the needs of hearing/sight impaired people
- On a more practical day-to-day level the group decided to produce a checklist for staff to use when admitting a person with sensory impairment, and to provide a policy in each ward on the access for hearing/guide dogs. Both these types of working dog are allowed in the wards and may remain with the patient if needed
- Developing stronger links with the relevant voluntary agencies was also identified as an action point
- A card or letter should be produced for patients to keep with them, holding relevant information about the resources being used, including an interpreter, to ensure continuity of care if patients move between wards or hospitals within the trust.
Taking the protocol forward
A working group was established to consider the protocol/procedure and prioritise the action points discussed above. This group was divided into three smaller groups to address:
A training programme has been developed for staff within the trust. The main aim is to raise awareness of the needs of people with visual, hearing and speech impairment when accessing our service. Two types of training have been developed, one for clinicians and one for non-clinicians. These are to be held quarterly.
The training highlights (Box 2):
- The most common eye conditions and how this can impact on individuals. These include cataracts, which make sight blurred or misty. Patients with cataracts may be easily dazzled by lights and colour may appear washed out. In glaucoma loss of vision occurs because of abnormally high pressure in the eye
- Types of hearing impairment and its effects. Types may include age-related hearing loss and tinnitus. Tinnitus involves patients hearing noises such as buzzing, ringing, whistling or other sounds and may result in tiredness and irritability, lack of concentration, anxiety and depression and withdrawal from social activities
- Common speech impairments (such as those caused by an accident or stroke) and how these impact on communication are discussed briefly and the need for this group of patients to be given clear information and more time to respond is emphasised
- What help staff can give individuals with any of these problems when accessing our service.
The sessions are held at the local Hearing and Sight Centre to make it easy to access any specialist equipment. The training sessions are very practical and hands on.
The communication group discussed how to get through to staff, patients, the public and other health-care and partner agencies. A trust public event was organised to encourage interaction between the trust and the local communities. This was held in the Guild Hall in the centre of Plymouth and was attended by trust staff, patients, the public and other health-care and partner agencies. Over 300 people attended the event during the day.
It was very useful in widening our contacts and gaining a broader insight into the needs of patients with sensory impairment from people who have some experience of the problems.
The group also decided to develop a pack to provide all trust staff with information on:
- Who to contact when accessing services for those with hearing/sight/speech impairment
- Guidelines for producing information and signs for visually impaired people
- How to support a visually impaired person
- How to talk with or telephone people who are deaf or hard of hearing, including those who use 'Type Talk' on a text phone
- Other information sheets
This group met with a representative of our neighbouring trust. It met only once, but by doing so opened the lines of communication and provided an opportunity to share developments in both trusts. The meeting identified some of the organisational processes that need to be in place to support service development. A steering group met regularly, providing a forum for the three sub-groups to feed back developments.
Ongoing awareness-raising and monitoring
A recent meeting agreed that the steering group should meet quarterly to ensure that these issues are kept on the agenda. The service continues to develop and interventions are evaluated.
The membership of the group has evolved over time and now includes representatives from estates, information technology and planning as well as clinicians, managers and representatives from the Hearing and Sight Centre and the Plymouth City Council Sensory Team.
A contract held with the Hearing and Sight Centre is being renegotiated. The steering group will monitor this contract and provide a forum where issues can be debated and developed. Further sub-groups may need to be developed to address outstanding issues.
The Patient Environment Action Group (PEAG) will include sensory impairment as a regular agenda item, which will be fed back to the steering group. We hope to provide information for patients about their roles and responsibilities and ours regarding sensory impairment as part of the 'patient involvement' strategy.
We will also look at capital planning scheme documentation to ensure that the Disability Discrimination Act questions are sensitive enough to pick up sensory impairment issues.
We are exploring opportunities to share good practice with other partner organisations who are invited to the steering group.
This work has taken 18 months so far and at times progress has seemed very slow. We have not yet addressed all the action points. No resources have been specifically dedicated to this work. At times it has been unclear of the best approach to take.
The work has been supported throughout by the director of service excellence but has been driven by staff in the trust committed to improving the patient experience. Progress has been made and the implications of it are wide reaching (Box 3).
Staff working with a person with sensory impairment should now feel more confident to ensure the patient and any carers receive equal access to a high-quality service.
This has been an important project for staff at this trust and is one that would be of benefit to other trusts.
The authors wish to acknowledge the contribution of Annie Barrett, the approved social worker, who was instrumental in starting this process, and all who have contributed to the steering group or the sub-groups. They would particularly like to thank Maggie Paine, Hearing and Sight Centre, Plymouth; David Jeffery, Plymouth Social Services Sensory Team and Mary Sutcliffe, Speech and Language Therapy, Plymouth.
Department of Education and Employment. (2000) The Disability Discrimination Act 1995: A guide for everybody. London: DEE.
Department of Health. (1997) Think Dual Sensory: Good practice guidelines for older people with dual sensory Loss. London: DoH.
Department of Health. (1999) Doubly Disabled: Equality for disabled people in the new NHS - access to services. London: DoH.
Department of Health. (2000a) A Practical Guide for Disabled People. Where to find information, services and equipment. London: DoH.
Department of Health. (2000b) Working in Partnership to Implement Section 21 of the Disability Discrimination Act 1995 Across the National Health Service. London: DoH.
Royal College of Physicians. (1998) Disabled People Using Hospitals: A charter and guidelines. London: RCP.
Royal National Institute of the Blind. (1995a) Challenging Blindness. London: RNIB.
Royal National Institute of the Blind. (1995b) Factsheet: Blindness: The facts. London: RNIB.
Royal National Institute for Deaf People. (2000) Statistics on Deafness. London: RNID.