APPENDIX 5
Memorandum submitted by the Royal National
Institute for Deaf People (RNID) (MS 07)
RNID SURVEY FINDINGS
1. In October 2001 RNID published Can't
Hear, Can't Benefit: A survey of deaf people's experiences of
claiming Disability Living Allowance. The survey was conducted
between September and August 2000 and included a number of questions
on medical assessments. 271 respondents in the sample had been
assessed by an examining medical practitioner (EMP). The key findings
on medical assessments were:
— 76 per cent of examinees said it
was difficult to communicate with the doctor.
— 40 per cent of those who had undergone
a medical assessment said they were dissatisfied with the doctor's
visit.
— One in five examinees (21 per cent)
said that the doctor did not ask them about their communication
needs.
— 30 per cent of examinees said that
the doctor did not seem to understand deafness. One in twelve
examinees (9 per cent) said that the doctor was rude.
— Over one in eight examinees (13 per
cent) said that communication support was needed but had not been
provided.
— Nearly two-thirds of examinees (63
per cent) were not informed that they had a right to communication
support during the assessment.
2. The satisfaction levels amongst deaf
claimants in the sample appear to be substantially lower than
those recorded in the Government's own customer surveys. In its
reply to the Social Security Committee's report on Medical Services
the Government said that 77 per cent of customers were satisfied
with medical assessments in DLA.[10]
In March 2001 DSS officials told the Public Accounts Committee
that recent customer surveys had shown satisfaction rates of 92-93
per cent.[11]
3. Respondents were asked why they were
dissatisfied with the doctor's visit. The most common complaint,
cited by nearly three-quarters of those dissatisfied (74 per cent),
was that the doctor did not appear to understand deafness. 9 per
cent said the doctor was rude, which also seems to indicate a
lack of deaf awareness on the part of the doctor. Also alarming
was the finding that over one in five deaf examinees (21 per cent)
said that they not been asked about their communication needs.
As deaf people qualify for DLA precisely on account of their communication
needs, the failure to ask about these needs effectively renders
these assessments incomplete.
4. Examinees were also asked if they had
experienced problems communicating with the examining doctor.
Three-quarters of examinees (76 per cent) found it difficult to
communicate with the doctor. Although 13 per cent of examinees
cited non-provision of communication support as the reason for
their dissatisfaction with the doctor, the fact that the overwhelming
majority of deaf examinees found it difficult to communicate with
the doctor suggests that the failure to arrange communication
support is a more widespread problem.
5. It is DWP policy to provide interpreters
for deaf people during medical assessments. However, 63 per cent
of those assessed by a Medical Services doctor were not informed
that they had a right to communication support during the assessment.
This may be due to the fact that, before 2001, the notification
letters did not advise deaf claimants of their right to an interpreter.
The current notification letter says "We will provide an
interpreter if required—or you may wish to arrange for a
friend or family member to interpret for you"[12]
However, this still puts the onus on the claimant to request communication
support and also allows for the use of non-professional interpreters
who may not be qualified to interpret accurately during medical
assessments.
6. Evidence provided to the National Audit
Office showed that 12 per cent of examining medical practitioner
visits during 2000, which were almost exclusively carried out
for DLA and AA, were deemed not "fit for purpose".[13]
The findings in the RNID survey suggest that many deaf claimants
are undergoing medical assessments that should have been classified
as unacceptable because interpreter support was not provided or
their communication needs were not properly assessed.
7. The fact that so many examinees reported
difficulties communicating with examining doctors suggests that
the Medical Services policy on communication support needs to
be reviewed. Accurate sign language interpretation during a medical
assessment is difficult for informal or unqualified interpreters
because medical and technical terminology cannot be easily translated
from English to British Sign Language (BSL). Only registered qualified
signed language interpreters can guarantee an accurate standard
of interpreting.
8. The level of dissatisfaction with medical
assessments amongst deaf respondents is unacceptably high. It
is alarming that 31 per cent of examinees in the sample felt the
doctor did not understand deafness. However, lack of deaf awareness
may only be part of the reason that 21 per cent of examinees complained
that the doctor did not ask them about their communication needs.
The medical report forms used in the assessment are inadequate
because they do not direct doctors to ask the right questions
about communication needs. As with the guidance to decision makers
the report forms do not reflect developments in the case law on
sensory impairment.
RECOMMENDATIONS
9. In our Can't Hear, Can't Benefit report
RNID recommended the following steps to improve the quality of
medical assessments for deaf people:
— Deaf awareness training should become
a core element of training for Medical Services' doctors.
— Medical assessments should only be
carried out using professional communication services not informal
interpreters.
— The DWP should develop deaf-specific
questionnaires for use by examining doctors.
— If a deaf claimant undergoes a medical
assessment without the requisite communication support the case
should be sent back to Medical Services for re-examination.
PROGRESS SINCE
THE LAUNCH
OF THE
REPORT
10. Since the launch of our DLA report,
SchlumbergerSema has been very willing to listen to RNID's specific
concerns. In February 2002 representatives from RNID met officials
from DWP, Corporate Medical Group, SchlumbergerSema, and the Appeals
Service, to discuss the report. SchlumbergerSema has now developed
a half-day sensory impairment training module which will be rolled-out
to all doctors over the next year. RNID was consulted over the
design of this training module and would like to see this welcome
initiative form part of the core induction training for all new
doctors.
11. Despite SchlumbergerSema evident desire
to improve the service to deaf people, RNID is still very concerned
that deaf sign language users continue to undergo medical assessments
without professional interpreters. We strongly recommend that
Medical Services' policy on interpreters is revised so that informal
or unqualified interpreters are no longer used. We would also
like to see training and guidance for staff arranging medical
assessments so that they are better equipped to understand deaf
people's communication needs and the types of communication services
available. For example, a deaf person whose preferred method of
communication is English may require a lipspeaker or palantypist.
12. RNID would like to see a mechanism for
returning cases for re-examination of deaf people if interpreters
have not been provided at the first assessment. We recognise that
this may not be easy to implement, as the need for, or absence
of an interpreter may not be recorded in the medical report. We
suggest that specific guidance is prepared for DWP decision makers
and Medical Services staff on how medical assessments for deaf
claimants should be conducted.
Duleep Allirajah
Welfare Benefits Policy Officer
4 April 2002
10 Report on Medical Services: Reply by the Government
to the Third Report of the Select Committee on Social Security
Session 1999-2000 [HC 183], DSS, Cm 4780. Back
11
Committee of Public Accounts, Minutes of Evidence, 21 March 2001,
The medical assessment of incapacity and disability benefits,
HC 366. Back
12
Medical Services leaflet AL1C (DV) Important information about
your medical examination. Back
13
The Medical Assessment of Incapacity and Disability Benefits,
National Audit Office, HC 280, March 2001.
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