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28 Mar 2006 : Column 241WH—continued

Deaf-blind People (Technology Access)

1.30 pm

Mr. Phil Willis (Harrogate and Knaresborough) (LD): It is difficult for those of us who enjoy the gifts of sight and hearing to imagine life without either, and impossible to imagine how we would cope. Today's short debate is about confronting the issues surrounding deaf-blindness and what society, the Government and Parliament can do to support deaf-blind people.

I pay tribute to Sense, the charity that supports deaf-blind people, and its 2005 report "Make Technology Work", which brought this key issue to the attention of the public and Parliament. I also recognise the contribution of many private sector companies in supporting deaf-blind people with technology. British Telecom has a long-standing tradition of providing assistance and assistive products to people with sensory impairments. I should also mention Ofcom: following the introduction of the Communications Act 2003, it did a great deal of work to encourage accessible electronic communications equipment.

Thankfully, relatively few people are deaf and blind; 23,000 people—fewer than 25 per constituency—are registered for both disabilities in the UK. That figure is small compared with the 378,000 registered as blind or partially sighted and the 8.9 million registered as deaf or hard of hearing.

Of course, very few people are completely deaf and blind; most have some residual sight or hearing. Some people are born deaf-blind as a result of maternal rubella, although thanks to vaccination that is very rare. Some genetic conditions such as Usher syndrome lead to deaf-blindness from late adolescence and people can become deaf-blind at any time through meningitis or accident. However, increasingly, age-related conditions result in sight and hearing loss, and those who already have a sight or hearing problem are particularly susceptible to dual loss later in life. It is therefore important that in responding, the Minister recognises the importance of supporting measures that can assist a wide spectrum of people with hearing and sight difficulties, and not simply the 23,000 registered as deaf-blind.

Remarkable breakthroughs in medical science have helped prevent deaf-blindness, and they will continue. Last week, the Chancellor announced that the Medical Research Council and the NHS research initiative will combine. That will make huge inroads into some of that work. However, today's generations of sufferers look to technology for support.

All of us—certainly those in this Chamber—use technology every day. For deaf-blind people, access to technology can be a matter of life and death. Research by Sense has shown that most deaf-blind people use assistive equipment, although sadly, about half of those surveyed have difficulties using the very technology that is there to help them. Many such problems are caused by manufacturers' lack of understanding of the needs of people with sensory impairments, and some of the difficulties could have been avoided if such needs had been considered carefully at the design stage.

Deaf-blindness is a low-incidence disability, meaning that there is low demand for some types of assistive equipment. That causes two problems: there is limited
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incentive for manufacturers to make such equipment, and it can be expensive to produce. Some of the equipment that deaf-blind people rely on, such as Braille clocks, vibrating light probes and sound monitors, is no longer available. That means that users who have got used to that technology often cannot get their equipment repaired or replace it if it stops working.

Low demand means that the market alone will never deliver accessible technology to this vulnerable group; intervention is needed. However, the legal situation is complicated. For instance, manufactured goods are excluded from the Disability Discrimination Act 2005 because they are regulated in Europe and not in the UK. It is ironic that someone with a sensory impairment can sue a retailer under the 2005 Act for refusing to serve them in a shop, but has no redress if none of the equipment on sale in the shop is accessible to them. That cannot be right.

Even when equipment is accessible to deaf-blind people, manufacturers are not obliged to produce instructions in accessible formats. Even the simplest equipment can cause huge difficulties for deaf-blind people. Hearing aids are vital for most such people; however, having a visual impairment makes hearing aids more difficult to use. Changing the battery in a hearing aid can be problematic for a person with low vision, because the battery and its chamber are so small; if the battery rolls away, it can be almost impossible to find. The hearing aid itself can be dropped, and for a person with hearing loss and poor vision, dropping a hearing aid on a patterned carpet can ruin a whole day. They would not be able to see the aid, nor hear where it fell. How on earth would they find it?

Television is a vital source of information and entertainment for most deaf-blind people and subtitling and audio descriptions are making an increasing proportion of programmes accessible. However, remote controls with rows and rows of small buttons with tiny writing can be difficult to operate. I confess that I—let alone somebody with sight and hearing problems—find them difficult to use. The on-screen menus used to operate some set-top boxes, video recorders and DVD players are inaccessible to many deaf-blind people. The colour scheme and fonts used can make them difficult to read, and there is no sound output.

Technology is of greatest use to deaf-blind people if it helps them to be independent when they are out and about. Take the case of Jim Hines, who is totally blind and has severe hearing loss. Last year, he had been away from London for a few days and was returning on the evening of Thursday 7 July; he knew nothing about the bombings. On arrival in London, he discovered that there were no tubes, buses or taxis at the station. Jim said:

Jim finally got the tube home on Friday morning. Only after arriving home did he learn what had happened. His friends and family had been trying to contact him. They had rung the casualty bureau, but he was not listed; one
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can imagine what they thought. Had Jim had a Braille mobile phone with SMS, he could have saved himself and his family huge anxiety, but such phones cost £3,000 and such technology is out of the reach of most deaf-blind people.

What can the Government do? First, let me acknowledge that the Government are doing some innovative work. I particularly compliment them for the initiative to provide tactile internet access for deaf-blind people and the £500,000 research programme that was led by the Defence Evaluation and Research Agency. Ability to use the internet can bring significant benefits for people with sensory impairments, and the translation of palm signing into internet communication through an interactive mouse may well revolutionise communication for deaf-blind people.

It would be interesting to hear from the Minister what other areas of research are planned by his Department. I acknowledge that it would be difficult for the Government to intervene in the commercial technology marketplace, but they have the chance to intervene through public procurement. That would have the twin effect of setting high standards for quality and accessibility and bringing costs down. For example, 700,000 people have now received digital hearing aids through the NHS, at a cost to the public purse of £65 to £75 per aid. Before the aids were available through the health service, people were paying up to £2,000 per aid privately. However, the excellent procurement arrangements organised by the Government need to be supported by reducing the unacceptable waiting times experienced in many areas of the country.

Perhaps the Minister will make a commitment today to include audiology, from GP referrals to the fitting of digital hearing devices, in the 18-week target for PCTs. If it is not included, we may well see that crucial service slip down the priority list as other funding pressures emerge. Perhaps he will go a step further, by reassuring the audiology service that recurring funding for service and replacement will be built into baseline budgets this year. Some £38 million was expected to go into routine audiology, but as yet there has been no commitment by the Department of Health.

The success of the Government's public procurement of digital hearing aids will hopefully give them confidence to seize other important opportunities on behalf of deaf-blind people. The mass distribution of set-top boxes to older and disabled people for the purposes of digital switchover is such an opportunity; it is a key one. That must not be a project just for the Department for Culture, Media and Sport but one in which the Department of Health plays a crucial role at the design stage. Digital broadcasting will open up huge opportunities for deaf-blind people, but if accessible technology is not built into the set-top boxes they will be lost. Will the Minister say what steps his Department is taking to influence the design of set-top boxes for the digital switchover?

Another opportunity for the Government to help stimulate demand for accessible technology is the new public sector duty to promote disability equality. Public sector bodies that are procuring equipment should undertake a disability equality impact assessment. Will the Minister tell us how the Government are monitoring that new public sector duty and what steps he intends to take to ensure that deaf-blind people receive appropriate assessment for, and advice about, technological aids by
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appropriately trained staff? That should be happening under his Department's guidance, but clearly it is not. The Sense survey found that 30 different types of professionals carried out assessments, ranging from therapists to social services staff. A simple step would be for the Minister to issue guidance on what qualifications assessors should have.

Sadly, the Government do not have direct responsibility for the regulation of manufactured goods and the issue of accessible technology; it is the responsibility of our friends in the European Parliament. However, I hope that the Government will make clear their representations in that key area. After all, a misunderstanding of the controls on a cooker can have disastrous effects for any of us, but for a deaf-blind person the problem is acute. Relatively simple universal tactile instructions on appliances such as cookers, ovens, washing machines and mobile phones would solve a great many of the problems, as would a legal requirement to make instruction booklets available in a format that could be used by deaf-blind people.

Despite the concerns of many deaf-blind people about the suitability of existing technology, many responded to the Sense survey in a positive way; whether we are talking about the use of Mobile Magnifier for mobile phones, the cordless telephone or the easier to read flat-screen TV, it is clear that where manufacturers design products with the deaf-blind in mind there is a great deal of satisfaction. Those products can be used by a wide range of other people. There was even praise for some manufacturers. Zanussi offers a simple Braille replacement for the front of its washing machines. It is a simple piece of technology that enables the machines to be used by a wide range of people.

Technology is improving all the time, but the fast pace of change also means that some deaf-blind people fear being left behind. The trend is for smaller pieces of equipment with more functions, and for more and smaller controls. Deaf-blind people are worried that the assistive equipment they own will quickly become out of date and that they will be unable to afford the high price of new equipment. Technology is vital for deaf-blind people, as it is for many of us. Our role as parliamentarians is to ensure that we work with the Government to ensure that their voice is heard.

1.44 pm

The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : It is pleasure to serve under your chairmanship again, Mr. Hood; I did so previously on the European Scrutiny Committee.

I congratulate the hon. Member for Harrogate and Knaresborough (Mr. Willis) on securing this important debate. I know that he has taken a keen interest in the subject of inclusive education for children. His commitment to ensuring that children with disabilities—particularly those with severe learning disabilities—have the chance to enjoy mainstream education is well known and much appreciated by Labour Members. I join him in paying tribute to Sense, which during my short time in Government has provided tremendous support and advice to me. I have much appreciated that.

Before I address the specific issue of this debate, I shall make a few opening remarks about the changing nature of this country's population. Tremendous advances
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have been made in the health service over the past six or seven years, which is not an accident; such advances have occurred because we have doubled the amount of money that has gone into it. As a result of the extra 100,000 staff who have been hired and the falling waiting lists, life expectancy has increased and infant mortality rates have decreased. This year, England has the lowest infant mortality rate in its history. Those medical advances and the advances in care and the national health service mean that more children will survive for longer, including many with severe learning disabilities.

Although the hon. Gentleman is right to say that advances in medical science mean that conditions such as deaf-blindness may in future be on the decrease, the number of children with complex disabilities surviving into adulthood may increase. The health and the care systems need to change to take account of that.

There are great opportunities to use technology to ensure that those individuals are able to live life to the full in future. I think that it was Albert Einstein who, at the beginning of the cold war, said:

Over the next few years we have the chance to reverse that aphorism, because technology will enable many people to fulfil the full potential of their humanity. For that to happen, it is vital that public services are reformed so that public servants who are responsible for delivering them have the freedom and flexibility to combine together in new ways to improve them.

The hon. Gentleman will know that our new White Paper confirms the vision set out in the social care Green Paper "Independence Well-being and Choice: Our Vision for the Future of Social Care for Adults in England" and sets out practical steps to turn that vision into reality. We talked about the need to bring far more personalised services together by improving assessment, for example by introducing individual budgets that bring five or six different income streams from across Government together in one care account for the individual to spend as they see fit. Supporting healthier, independent lives through a proper risk-management framework will be important, as will a much stronger emphasis on preventive services in the future.

Key to all of this is ensuring that the national health service, social care and other local government services, in particular housing, are orchestrated together in a completely new way. That better integration involves thinking holistically about the needs of the individual, rather than simply questioning their eligibility and finding ways to deny them service. This agenda is about empowerment. That personalisation is about listening to individuals, recognising their ability to determine what they need and then delivering the sorts of services that are necessary to them.

I want to highlight the things that we hope to sweep away, one of which was highlighted by the Commission for Social Care Inspection report "Real Voices, Real Choices" that was published this week. It stated:

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That is exactly the sort of problem that we want to address by bringing the health service and the social care system far closer together.

This is not a trivial ambition; it is about something important. In the past seven years we have delivered the longest period of uninterrupted economic growth ever known in this country. More people are in work than ever before and we have created a couple of million new businesses. This society is far richer in opportunity, but the challenge is now for us to ensure that everybody in the country has the chance to flourish to the full, irrespective of their background or ethnicity, where they live or what circumstances they have encountered in life.

We know that disabled people are less likely to be in full-time education or in work. They are more likely to feel a lack of confidence and a lack of support. The reasons behind that are not straightforward, nor are they always related to somebody's health impairment or health condition. Attitudes in society play a significant part. How we structure our services for disabled young people is crucial. That is why the extension of the disability discrimination legislation, the establishment of the Disability Rights Commission and changing the ways in which Jobcentre Plus and Connexions work are very important. Those are ambitions that were encapsulated in our 20-year strategy set out in the "Improving the life chances of disabled people" report. Its aim is very simple but also very powerful: to ensure that disabled people will be given the maximum opportunity to fulfil their potential.

I shall talk about some of the necessary practical steps, and respond to some of the important points raised by the hon. Gentleman. First, we know that working together at both central Government level and local level is essential. That is why we set up the Office for Disability Issues, to act as a bridge between Departments at the centre by creating the mechanisms to ensure that they work together more effectively. That is not just to do with health and social care issues; it is also to do with matters handled by other Departments, such as trade and industry. The work of the Department of Trade and Industry has an important bearing on this agenda.

Examples of how that joint working manifests itself are already coming through. We are supporting services at the local level—for example, by working with a wide range of groups to develop revised eye care pathways. In addition to the certificate of vision impairment, we have developed two new documents for use in hospitals and on the high street to facilitate easier access to support services prior to certification. Why is that important? One reason is that it will help social services identify people who need support in a timelier manner, before they lose independence and confidence.

Another key way to deliver change is through changing the work force. That is why I am glad to be able to say that the Department of Health is working with the Guide Dogs for the Blind Association—in collaboration with other employers—on a project to redesign hybrid rehabilitation functions in work with visually impaired people. Also, Skills for Care and the Children's Workforce Development Council are managing pilots to look at work force reform. It is important to ensure that there are new kinds of worker
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with different sorts of skills because, as the hon. Gentleman highlighted, the problem of assessment is sometimes difficult.

We are backing these ambitions with significant sums of new investment. If we combine the amount of money that is going into the health service over the next two years with the extra resources going into local authorities, the total sum is somewhere north of £20 billion. That represents a significant step up in available resources, and I am proud to be able to say that it includes £80 million for the preventive technologies grant, which comes on stream in a few days; local authorities will have the flexibility to invest in a range of services. We have looked into procurement arrangements as part of the planning for the spending of that grant, and I will ask Department officials to examine how issues around deaf-blindness have been considered in the development of guidance for the spending of the money, because that could provide an important opportunity over the next one to two years.

There is strong international evidence that we can improve the quality of care through technology. The hon. Gentleman asked about that. The new and emerging applications of the technology programme cover all areas of health and social care; there is a budget of about £1.2 million to develop new and innovative uses of technology. In addition, the annual budget for the health care technology development programme is £2 million. The remit of that programme covers novel information technology that looks into how there might be significant improvements in the performance of health care technologies. Recently funded projects include many of direct relevance to disabled people, such as speech-driven environmental control systems, stair-climbing and walking aids, which are very practical applications. For a number of years, the policy research programme has provided a horizon-scanning role in relation to developments in information and communication technologies. All of these things are important, but unless they are translated into front-line practice, they will be of little benefit to the 20 to 25 people in each of our constituencies who might be deaf-blind.

We have said that we expect the directors of adult social services in every part of the country to work in partnership with a range of agencies, including children's services, and health, housing and transport organisations, in order to examine what are the strategic needs of every community. We will provide guidance on how that exercise should be best performed. We expect directors of adult social services to work hand in glove with directors of public health to make sure that there is a shared understanding of the needs of different groups in every community. I said to the House a week or two
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ago that, given the number of people with sensory impairments in this country, we would expect such strategic needs assessments to take good account of those needs.

One of the reasons why that is important is that we will expect local authorities to ensure that adequate arrangements are in place for people with sensory impairments or other disabilities to be able to access services in the first place. Often, those barriers to access are among the most difficult hurdles for people with disabilities to leap. To ensure that there is this emphasis on service access, the Department of Health is working closely with the Disability Rights Commission. We have jointly produced leaflets—such as "You can make a difference: improving hospital services for disabled people"—for front-line staff in both primary and secondary care. They are important because they explain, and give practical examples of, the ways in which front-line staff can meet the access requirements of the Disability Discrimination Act 1995. We are also ensuring that all health and social care staff are aware of the needs of disabled people. The Department of Health and the DRC are producing a comprehensive education and learning programme, which will be available later this year.

My final point is that, as we set about undertaking this process of public service reform over the coming years, it is important that change is not just drawn up and designed in Whitehall—or even in the House. Instead, we should listen to the voices of people who need the services as we think about how they should be configured. The CSCI is doing that by involving people who use such services in its inspection process. Its report "Real Voices, Real Choices", which I referred to earlier, considers the qualities people expect from care services and how that feeds into the inspection processes. It spoke to people who use services, and, importantly, it also spoke to their carers—there are 6 million carers in this country—and those who represent them. What it found was something that we all probably know in our heart of hearts, because it is simple: people want choice and flexibility in respect of services, as well as creative problem solving, and they also want information that is available at the right time. In other words, they want to be treated with respect by a system that is fair, and which has the capacity to treat them as grown-ups and to let them, where appropriate, take risks.

We emphasised all those messages in the Green Paper on adult social care and in the White Paper. They reflect what people tell us time and again, and we must now translate that into action, in order to make a genuine difference to people's lives.

Question put and agreed to.

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