Download Draft regulations and guidance for implementation of the Care Act

14 August 2014
Action on Hearing Loss Consultation Response to ‘Care Act 2014: How should
local authorities deliver the care and support reforms?’
About us
Action on Hearing Loss is the new name for RNID. We're the charity working for a
world where hearing loss doesn't limit or label people, where tinnitus is silenced –
and where people value and look after their hearing. Action on Hearing Loss
provides information and support on all aspects of deafness, hearing loss and
tinnitus. We also offer a range of care and support services across the UK, including
running community-based hearing aid support and befriending services; Sensory
Services on behalf of local authorities; and care and support services to people who
are deaf, deafblind or who have a hearing loss alongside additional needs.
Our response focuses on key evidence that relates to people with hearing loss and
the people to whom we provide care. Throughout this response we use the term
'people with hearing loss' to refer to people with all levels of hearing loss and tinnitus,
including people who are profoundly deaf. We are happy for the details of this
response to be made public and we would also be happy to be contacted for more
evidence and information.
Table of Contents
Page number
Introduction
2
Response to the Wellbeing guidance
4
Response to the Prevention guidance
5
Response to the Information & Advice guidance
8
Response to the Market Shaping guidance
12
Response to the Assessment regulations and guidance
14
Response to the Eligibility regulations and guidance
15
Response to the Personal Budgets guidance
17
Response to the Person-centred planning guidance
18
Response to the Integration & Cooperation guidance
19
Response to the Delayed transfers of Care regulations
21
Response to the Prison/Bail Premises guidance
22
1
Introduction
Action on Hearing Loss welcomes the opportunity to respond to this consultation
from the Department of Health. As a member of the Care and Support Alliance, we
have fed comments back to the Department of Health through the Care and Support
Alliance engagement meetings and formal consultation response. Below we present
the additional comments that we propose on behalf of the ten million people with
hearing loss in the UK – one in six of the population.
Prevalence of hearing loss increases with age, with 42% of people aged over 50
affected by hearing loss, rising to 71% of people aged over 70. Around 250,000
people in the UK’s care homes are affected1. As our population ages this number of
people affected is set to grow. By 2032, there will be almost half a million people
with hearing loss in the UK’s care homes2.
If it is not managed effectively, hearing loss can cause communication difficulties and
social isolation and often has a significant impact on an individual’s overall health,
wellbeing and independence. There is also evidence of a link between hearing loss
and dementia3, as well as extensive evidence that unaddressed hearing loss leads
to mental health problems such as depression and anxiety4. This means that an
individual is likely to require more intensive and costly care and support if their
hearing loss is not addressed and effectively managed at an early stage.
Local authorities play an important role in supporting people to address and
effectively manage their hearing loss by assessing people’s needs, preventing and
delaying the development of needs, providing advice and information, support and
equipment, and signposting and referrals.
Action on Hearing Loss broadly welcomes the proposed regulations and guidance to
accompany the Care Act 2014. However, to ensure these reforms meet the needs
of people with hearing loss, we suggest the following recommendations:
1. Whilst we agree that an understanding of local population need should be the
basis for local strategies, many local authorities fail to recognise hearing loss
in their JSNAs. Even if hearing loss is not specifically mentioned in the
JSNA, local authorities must take account of the specific communication
needs of people with hearing loss in their local strategies and commissioning.
1
Action on Hearing Loss Hearing Matters 2011
Action on Hearing Loss A World of Silence 2012
3
People with mild hearing loss are twice as likely to develop dementia than people without any hearing loss,
and it increases to three times as likely for those with moderate hearing loss. Lin et al. (2011) Hearing loss and
incident dementia. Archives of Neurology 68(2): 214-220
4
Saito et al (2010) Hearing handicap predicts the development of depressive symptoms after three years in
older community-dwelling Japanese. Journal of the American Geriatrics Society 58, 1, 93-7; National Council
on Aging (2000). The consequences of untreated hearing loss in older persons. Head and Neck Nursing, 18(1)
2
2
2. We believe that the national minimum eligibility threshold should be set at the
equivalent of ‘moderate’ FACS, with sufficient funding for local authorities to
meet their duties under the regulations. As a fundamental human right which
has a huge impact on well-being and quality of life, the ability to communicate
should also be included as a specified outcome in the eligibility criteria.
3. We strongly support the duties and guidance relating to improved accessibility
of services. We recommend the inclusion of a list of example accessible
formats to ensure that local authorities are able to act on this guidance.
Contact details
Christina Lowe, Research and Policy Officer
Email: [email protected]
3
Response to the Wellbeing guidance
1.9 We welcome the recognition that everyone’s needs are different, and that local
authorities will have to consider how to meet each person’s specific needs. The
needs of each individual with hearing loss will vary, and it is vital that they are each
given the opportunity to explain their communication needs and the support that they
require to achieve improved outcomes in their health, wellbeing and independence.
1.13(a) We support the notion that local authorities should start from the assumption
that an individual is best-placed to judge their own wellbeing.
1.22. We support the assertion that promoting wellbeing is not always about local
authorities meeting needs directly. As a voluntary sector organisation, we run a
number of services aimed at improving the wellbeing of people with hearing loss, for
example befriending services, and services to provide people with practical support
relating to their hearing aid maintenance. We encourage local authorities to work
with the voluntary sector and to make arrangements to signpost people to these
services as appropriate.
4
Response to the Prevention guidance
It is very positive that the prevention duty extends to all people in a local authority’s
area, including carers, regardless of whether they have needs for care and support.
We welcome the encouragement to make the most of the resources available in the
community – for instance, local support networks or voluntary services. We provide
a great deal of information and community-based services that can play an important
role in supporting people with the management of their hearing loss and other needs.
We encourage local authorities to contact us for more information.
3. Is the description of prevention as primary, secondary or tertiary, a helpful
illustration of who may benefit from preventative interventions, when and what those
interventions may be?
We appreciate the descriptions of prevention as primary, secondary or tertiary
although these should not be taken by commissioners as indicating rank or
importance. In relation to hearing loss, there are a number of prevention services
that we encourage local authorities to consider.
Prevent: primary prevention / promoting wellbeing
As stated in paragraph 2.6, local authorities should encourage all residents to
maintain an active and healthy lifestyle. Good hearing health is an important part of
overall health and wellbeing, and local authorities should encourage people to look
after their hearing. Noise-induced hearing loss is a preventable condition that can
occur if an individual is regularly exposed to damaging levels of noise over long
periods of time, at work or through personal listening habits. Exposure to noise has
been shown to be associated with: increased levels of stress hormones in the blood;
greater likelihood of cardiovascular disease; and increased risk of developing a
mental illness, and cognitive impairments amongst children.5
To prevent noise-induced hearing loss, public health messages about the dangers of
loud noise and ways to protect hearing should be shared, with a particular focus on
targeting high-risk audiences such as young people, music fans and employees in
loud work environments.
Reduce: secondary prevention / early intervention
Early intervention is essential for the effective management of hearing loss.
Estimates suggest that at present only two million of the six million people that could
benefit from hearing aids have accessed them, leaving an estimated four million
people with unmet needs6. Research also shows that people wait on average ten
years after noticing symptoms before they seek help for their hearing loss, and that
5
Ad Hoc Expert Group on Noise and Health (2010) Environmental noise and health in the UK. Health
Protection Agency: Didcot
6
Action on Hearing Loss (2011). Hearing Matters. Available at: www.hearingloss.org.uk/hearingmatters
5
the average age of those referred for hearing assessment is in the mid-70s, by which
point their ability to adapt and benefit from a hearing aid is greatly reduced 7.
Unaddressed hearing loss can cause communication difficulties and social isolation
and often has a significant impact on an individual’s overall health, wellbeing and
independence. There is also evidence of a link between hearing loss and dementia 8,
as well as extensive evidence that unaddressed hearing loss leads to mental health
problems such as depression and anxiety.9 This means that an individual is likely to
require more intensive and costly care and support if their hearing loss is not
addressed and effectively managed at an early stage.
It is therefore imperative that local health and social care organisations take action to
encourage early intervention to support people to address and effectively manage
hearing loss. Health and care professionals are in a beneficial position to
encourage people who may have hearing loss to seek help at a point when they are
receptive to advice about their health and wellbeing. Health and care professionals
should have thorough training in recognising hearing loss and responding
appropriately by referring individuals for a hearing test. Hearing checks or hearing
screening should be incorporated into general health or wellbeing checks, as well as
when patients are admitted or discharged from acute care or intermediate care.
Individuals should be referred for a full hearing assessment (either directly, or via the
GP) when staff recognise signs of hearing loss.
Individuals who are referred to or present themselves to local authorities for other
conditions that are closely associated with hearing loss should be encouraged to
check their hearing and address any hearing loss. Common conditions that often cooccur with hearing loss include: dementia, cardiovascular disease, stroke, diabetes,
mental health, Parkinson’s and sight loss. Please see our research report ‘Joining
Up’ for more information10.
Delay: tertiary Prevention
People who have been diagnosed with hearing loss should be provided with the
support they need to maximise their independence and skills. Examples of
equipment, technology and additional services that can help people to more
effectively manage their hearing loss and delay their need for more intensive support
7
Davis, A., Smith, P., Ferguson, M., Stephens, D., & Gianopoulos, I. (2007). Acceptability, benefit and costs of
early screening for hearing disability: A study of potential screening tests and models. Health Technology
Assessment, 11, 1–294
8
People with mild hearing loss are twice as likely to develop dementia than people without any hearing loss,
and it increases to three times as likely for those with moderate hearing loss. Lin et al. (2011) Hearing loss and
incident dementia. Archives of Neurology 68(2): 214-220
9
Saito et al (2010) Hearing handicap predicts the development of depressive symptoms after three years in
older community-dwelling Japanese. Journal of the American Geriatrics Society 58, 1, 93-7; National Council
on Aging (2000). The consequences of untreated hearing loss in older persons. Head and Neck Nursing, 18(1)
10
Action on Hearing Loss (2013) Joining Up: Why people with hearing loss or deafness would benefit from an
integrated response to long-term conditions. Available at: www.hearingloss.org.uk/joiningup
6
include: the aids and adaptations peer support groups, hearing therapy and
specialist counselling, and lipreading classes, available through local authorities or
other local services. Local authorities must make a greater effort to signpost people
with hearing loss to these support services. For example, at present many health
and social care professionals are failing to provide people with hearing loss with
information about local lipreading classes, despite the fact that lipreading classes are
one of the best forms of reablement available to people with hearing loss. The
benefits of these classes are outlined in our research report ‘Not Just Lip Service:
Why it’s time to recognise the value of lipreading and managing hearing loss
support’11.
11
Ringham (2013). Not Just Lip Service: Why it’s time to recognise the value of lipreading and managing
hearing loss support. Available at: www.hearingloss.org.uk/lipreading
7
Response to the Information & Advice guidance
Question 5: Views are invited about how local authorities should coordinate and
target information to those who have specific health and care and support needs.
As highlighted in the guidance (paragraph 3.3), local authorities must take an active
role both in providing information and in ensuring that the information and advice
provision in their area is coherent, sufficient and made available to the whole
population.
For people with hearing loss, local authorities can fulfil their duty to facilitate access
to information and advice (paragraph 3.3) by making sure information is available in
an accessible format and by ensuring that information is present in key locations
where people with hearing loss are likely to access it. These include: deaf and hard
of hearing groups, lipreading classes, audiology departments and community-based
clinics, GP surgeries, hospitals, public libraries, Senior Citizens’ Forums, Age UK
groups, town halls, and post offices.
As identified in paragraph 3.15, there are people who have not presented to local
authorities for assessment who are nevertheless likely to be in need of care and
support, provided through local authority or otherwise. This is certainly the case with
people with hearing loss; of the ten million people with hearing loss in the UK, four
million people could benefit from hearing aids, support or equipment but have yet to
acknowledge or address their condition. This failure to effectively manage their
impairment may in some cases have a significant impact on their safety,
independence and wellbeing. Local authorities should play an active role in
encouraging these people to address and manage their hearing loss.
We welcome the recommendation in paragraph 3.4 for local authorities to provide
information and advice about prevention of care and support needs, finances, health,
housing, employment, cases of abuse or neglect, and other areas, in addition to
basic information about care and support. In relation to hearing loss, this includes
providing information about:
-
-
-
Treatment and rehabilitation for hearing loss e.g. having a hearing
assessment, getting and using hearing aids, requesting support services that
may be available through the local authority, such as lipreading classes,
counselling or hearing therapy
Products and equipment that can support an individual to adapt to their
hearing loss, including the aids and adaptations that may be available through
a local authority’s sensory services –e.g. a hearing loop system, a textphone,
a vibrating alarm clock, a telephone amplifier, devices that use flashing lights
and/or vibrating pads to alert when a doorbell, telephone or smoke alarm is
ringing
Benefits that may be appropriate to support a person with hearing loss e.g.
Personal Independence Payments / the Disability Living Allowance; the
Employment and Support Allowance; Attendance Allowance; the Industrial
8
-
Injuries Disablement Benefit; Carer’s Allowance; the Community Care Grants
from the Social Fund; Armed Forces Compensation Scheme
Support in a workplace or educational setting e.g. Access to Work or Disabled
Students’ Allowances
Discounted travel available for people with hearing loss
As stated in paragraph 3.15, this information should be provided both to people with
care and support needs themselves, and to their family and carers. Our research
has found that the family and friends of people with hearing loss can play a central
role in determining how effectively an individual is able to manage their condition12.
It is therefore important that local authorities provide family and carers with the
information that they require to support the person with hearing loss.
In order for local authorities to coordinate information for people with specific health
and care needs, it is essential that the local authority engages with people with
hearing loss, the people who surround them, the wider public and local providers of
information and advice for people with hearing loss (paragraph 3.12). We welcome
the requirement in paragraph 3.13 for local authorities to understand, coordinate and
make effective use of other statutory, voluntary and/or private information and advice
resources. As a voluntary organisation that provides information and advice to
people with hearing loss on a national and local level, we are keen to ensure that this
service is well coordinated and makes best use of the available knowledge and
resources.
We support the requirement for local authorities to ensure there is an accessible
information and advice service that meets the needs of its population, including
people with sensory impairments (paragraph 3.17 and 3.20). Some local authorities
may be unsure about what ‘accessible formats’ means for people with particular
disabilities. We therefore recommend that the guidance is amended to include
examples of accessible formats. Examples of accessible formats that people with
hearing loss may require include:
-
Textphones
Text Relay
SMS Text
Instant messaging
Video Relay
Written material in plain English
Videos with subtitles and BSL interpretation
BSL translation of key written information
Communicating through a live or remote communication support professional,
for example a BSL interpreter, lipspeaker, notetaker or speech to text reporter
Communicating with the support of equipment such as a personal listener or a
hearing loop system
12
Echalier (2010). In it together: the impact of hearing loss on personal relationships. Available at:
www.hearingloss.org.uk/supporting-you/policy-research-and-influencing/research/our-researchreports/research-reports-2010.aspx
9
We are happy to be contacted for further guidance about accessibility.
We welcome the reference to local authorities’ duty under the Equality Act to make
reasonable adjustments to ensure disabled people have equal access to their
services. It is also positive that the guidance signposts local authorities to NHS
England’s forthcoming Accessible Information Standard (ISB 1605). This standard
will provide extensive guidance to support local authorities to identify, record, share
and meet the needs of people with hearing loss, sight loss and learning disabilities.
Following the standard’s guidance will enable local authorities to fulfil their duty in the
Care Act regulations to pay due regard to the needs of people with sensory
impairments and learning disabilities. We suggest the following amendments to
paragraph 3.19 of the guidance in order to ensure people with hearing loss are not
excluded:
Information and advice channels are likely to include all of the following:
- Face-to-face contact, with communication support if necessary
- Telephone and textphone
Whilst it is vital that all non-verbal information is provided in an accessible format, it
is also essential that staff providing verbal information are fully trained in the
communication needs of people with particular communication requirements,
including people with hearing loss. Deaf awareness training can provide staff with
information about Text Relay and loop systems; best practice for working with
Communication Support Professionals; basic sign language and communication
tactics. The importance of regular deaf awareness training for all frontline staff
should not be underestimated. We therefore fully support the recommendation for all
frontline staff to be aware of accessibility issues and appropriately trained (paragraph
3.28).
We strongly support the duty in paragraph 3.29 for local authorities to ensure that all
relevant information is available to people for them to make the best informed
decision in their particular circumstances. It is essential that local authorities take a
proactive role in this regard; many people with hearing loss will not know what
information to request in an accessible format without guidance from the local
authority about what information could be made available.
In paragraph 3.49, the guidance sets out the requirement for local authorities to
provide information and advice on local arrangements for receiving and dealing with
complaints and what support is available to people to enable them to complain.
Requirements relating to the provision of information in accessible formats also apply
to complaints procedures, and local authorities must take care to ensure that people
with particular communication needs are provided with accessible information and
communication support to explain complaints procedures and to enable them to
complain.
10
We welcome the recommendation for local authorities to engage all relevant
stakeholders in the development of information and advice plans and implementation
(paragraph 3.55). Active steps must be taken to ensure that people with hearing
loss are able to take part in the engagement process.
With regards to a local authority’s duty to work with local CCGS and other partners to
undertake JSNA and JHWS (paragraph 3.53), it is vital that the JSNA truly reflects
the diverse range of needs of the local population. Our 2013 research found a
worrying lack of recognition of the high prevalence and significant impacts of hearing
loss in local authorities’ population data and plans13. In England, only one-third of
directors of Adult Social Services said that hearing loss appears as a specific issue
in their JSNA, and only half of Adult Social Services have a sensory or hearing loss
loss strategy. Hearing loss affects one in six people and tinnitus affects one in ten
people; both conditions can have a significant impact on their health and wellbeing.
Local Authorities must ensure that these common conditions are reflected in their
data and analyses relating to local population needs. This will then result in an
improved ability to make accurate and effective local strategies and plans for “what
health and social care information the community needs, including how they access
it and what support they may need to understand it”.
Given the lack of analysis of the prevalence and impacts of hearing loss in many
JSNAs, we are concerned by the encouragement in paragraph 3.56 for local
authorities to look to JSNAs to identify the factors to consider for the provision of
their information and advice service. It is therefore vital that every local authority
takes into account the specific communication needs of people with hearing loss,
regardless of whether or not these needs have been accurately represented in their
local JSNA.
We welcome the recommendation in paragraph 3.57 for local authorities to review
and publish information about the effectiveness of their information and advice
service. As a large user group with specific communication needs, we encourage
local authorities to seek feedback from people with hearing loss during this review
process.
As the largest national charity providing information and support for people with
hearing loss, the guidance should signpost people to the website and resources of
Action on Hearing Loss: www.actiononhearingloss.org.uk in the list of relevant links.
13
Calton (2013) Life Support: The provision of social care for people with hearing loss. Available at:
www.hearingloss.org.uk/lifesupport
11
Response to the Market Shaping guidance
Question 8: Are there any further suggestions of case studies or tools that can assist
local authorities in carrying out their market shaping and commissioning activities?
There are several tools that can assist local authorities in identifying the number of
people with sensory loss in their local area, which will then enable them to effectively
carry out their market shaping and commissioning activities for this group. For sight
loss, RNIB has developed a data tool for local authorities, available at:
http://www.rnib.org.uk/knowledge-and-research-hub-key-information-andstatistics/sight-loss-data-tool . Action on Hearing Loss is also developing a tool to
support local authorities with data about people with hearing loss. In the meantime
we can provide local data templates and guidance about the number of people in a
particular local area with hearing loss. We would strongly encourage local
authorities to contact us for this information and advice.
4.2 We support the requirement for local authorities to facilitate and shape their
market for adult care and support as a whole, so that it meets the needs of all people
in their area who need care and support. One of the most common conditions
affecting adults with care and support needs is hearing loss; this affects more than
three-quarters of mainstream care users. It is therefore essential that local
authorities ensure that the market in their area meets the communication and care
needs of people with hearing loss.
4.22. When arranging services themselves, local authorities must ensure their
commissioning practices and the services delivered on their behalf comply with the
requirements of the Equality Act 2010, and do not discriminate against people with
protected characteristics.
Within the category of ‘disability’, hearing loss is one of the protected characteristics
under the Equality Act. Local authorities must ensure that services in their area
make reasonable adjustments to support people with hearing loss, including people
who are hard of hearing and those who are profoundly deaf and use British Sign
Language as their first language.
4.40. We welcome the encouragement for local authorities to consider the sufficiency
and diversity of all types of service, including specialist care. People who are deaf
and have other conditions have complex needs and must be able to access
specialist care services. Local authorities must ensure that these needs are
identified within their strategies and that this results in referrals to appropriate
specialist care.
At present, the NHS recognises the complexity of needs of people who have mental
ill health alongside substance misuse problems. Dual diagnosis in these cases
ensures that these people are referred to the specialist care that they require.
However, in the case of those who are deaf and have other conditions, local
12
authorities often fail to recognise the complexity of their dual needs- this has resulted
in inappropriate referral to generic care and support services, rather than the
necessary specialist services that they require.
4.48. Given that the market shaping and commissioning intentions will be crossreferenced to the JSNA, it is vital that the JSNA truly reflects the diverse range of
needs of the local population. Our ‘Life Support’ research found a worrying lack of
recognition of hearing loss in local authority’s population data14. In England, only
one-third of directors of Adult Social Services said that hearing loss appears as a
specific issue in their JSNA, and only half of Adult Social Services have a sensory
loss strategy. Hearing loss affects one in six people and tinnitus affects one in ten
people; both conditions can have a significant impact on their health and wellbeing.
Local Authorities must ensure that these common conditions are reflected in their
analyses and strategies relating to local population needs.
4.57 We support the impetus for local authorities to arrange engagement with hardto-reach individuals and groups, including those who face communication difficulties.
We suggest that the text is amended from ‘who have communication issues’ to ‘who
face communication difficulties’.
4.66. We welcome the recognition of the services and support provided by the
voluntary sector and the encouragement for local authorities to plan strategically to
encourage, make best use of and grow these essential activities to integrate them
with formal care and support services.
To continue to grow their ‘community assets’, commissioners must ensure that
people with disabilities are able to contribute and develop their many and diverse
skills. There is currently no access to communication support funding for volunteers.
This is socially excluding and has meant that people who are deaf are barred from
being part of ‘Big Society’ unless they can afford to fund their own support.
Volunteers have a large role to play in the delivery of care & support and
apprenticeships from volunteering may lead to employment in the sector. People
who have hearing loss must be given appropriate support so that they can volunteer.
14
Calton (2013) Life Support: The provision of social care for people with hearing loss. Available at:
www.hearingloss.org.uk/lifesupport
13
Response to the Assessment regulations and guidance
Regulations
3(1) We welcome the requirement for a local authority to carry out an assessment in
a manner which is appropriate and proportionate to the needs and circumstances of
the individual to whom it relates; and having regard to the importance of ensuring
that the individual is able to participate in the process as effectively as possible.
People with hearing loss have specific needs that must be taken into account in
order for them to participate effectively in the assessment process, for example
access to communication support such as a fully qualified British Sign Language
(BSL) interpreter, or equipment such as a personal listener. Our ‘Life Support’
research surveyed local authorities in England and Wales15. The research found
that when a BSL user needs information or an assessment, in some cases a team
member trained to interpreter level (level 6) in BSL is available. But in the majority of
cases the service is delivered by an underqualified interpreter, either a member of
the team with no formal BSL training or up to level 3 BSL, or a friend or family
member. Better processes must be introduced to book proper communication
support where it is needed.
3(5) We welcome the requirement for local authorities to provide information prior to
the assessment in a format which is accessible to the individual. People with
hearing loss may require information in particular formats. For example, for some
British Sign Language users English may be a second language and therefore all
written information should use plain English and key information should be provided
with a BSL translation.
Guidance
6.3 We support the emphasis on prevention and early intervention, and the
recognition that the outcome of an assessment may range from offering guidance
and information to arranging for services to meet those needs. Many people with
hearing loss have not yet taken action to address the condition. Health and social
care professionals must make the most of appropriate opportunities to support
people with hearing loss to acknowledge and effectively manage their condition.
6.5 It is essential that assessors are appropriately trained to work with people with
hearing loss. Ten million people in the UK have hearing loss and many of them will
require assessments for this or other conditions; this includes people who are hard of
hearing as well as people who are severely or profoundly deaf, some of whom use
British Sign Language as a first language. Proper deaf awareness training and
regular refresher sessions are required to ensure assessors understand and respond
15
Calton (2013) Life Support: The provision of social care for people with hearing loss. Available at:
www.hearingloss.org.uk/lifesupport
14
appropriately to the communication needs of people with different levels of hearing
loss.
6.36. We welcome the encouragement for local authorities to establish the
individual’s communication needs and seek to adapt the assessment process
accordingly. These adjustments are vital to enable people with hearing loss to
participate fully in the assessment process.
As mentioned above, better processes must be introduced to book qualified
communication support for people with hearing loss where it is needed. Our 2013
survey of local authorities in England and Wales found that in the majority of cases
when BSL users need information or an assessment they are not given a qualified
interpreter, instead having to rely on a member of the team with no formal BSL
training or up to level 3 in BSL, or sometimes a friend or family member who
interprets on behalf of the client16.
Response to the Eligibility regulations and guidance
Question 14: Do the draft eligibility regulations, together with powers to meet other
needs at local discretion, describe the national eligibility threshold at a level that will
allow local authorities to maintain their existing level of access to care and support in
April 2015? If you believe they don’t please explain your reasons for this.
As part of the Care and Support Alliance (CSA), we are fully supportive of the points
raised in the CSA’s response to the eligibility regulations and guidance. The
following points are of particular importance to people with hearing loss:
We understand that the Government’s intention is for regulations to set the national
minimum eligibility threshold at the equivalent of ‘substantial’ Fair Access to Care
Services (FACS), the level currently adopted by the majority of councils. In our view,
this threshold is too high and will exclude carers, older and disabled people from
essential support. We believe that the threshold should be set at the equivalent of
‘moderate’ FACS, with sufficient funding for local authorities to meet their duties
under the regulations.
In relation to adults, we believe that the proposed regulations represent a tightening
of the current ‘substantial’ level of care, due to the conditions set out in Clause 2 of
the regulations. We know that many people with hearing loss are currently unable to
access the care and support they require due to high local eligibility thresholds. We
fear that the new criteria will continue to exclude many people who require care and
support.
16
Calton (2013) Life Support: The provision of social care for people with hearing loss. Available at:
www.hearingloss.org.uk/lifesupport
15
Omissions from the current criteria
Communication
As the regulations are currently drafted, a person’s communication needs may only
be considered eligible if they relate to one of the other specified outcomes – for
example if a person is not able to access necessary facilities or services in the
community because they are not able to communicate. However, we believe that the
ability to communicate and make oneself understood is a fundamental human right
which has a huge impact on well-being and quality of life and must be included as a
specified outcome in its own right.
CSA members are aware of people in different circumstances who need support but
may not be eligible for it.
Clause 2 (2) Specified outcomes
Clause 2 (2) (3) 3 (4) (b) (i) basic care activities
‘Some or all’ The meaning of this phrase is currently unclear and we are concerned
that leaving it solely to local authority interpretation could result in variations in
eligibility and subsequent care packages. This undermines the aim of a national
threshold to improve equity and consistency across the country. The change from
‘one or more’ in the draft regulations published in June and the ‘some or all’ in the
current draft represents a considerable tightening of the eligibility criteria.
Question 18: Does the guidance adequately describe what local authorities should
take into consideration during the assessment and eligibility process?
Unlike other chapters of guidance, this guidance does not currently state that the
record of a decision about eligible needs must be provided in a format that is
accessible to the person who has been assessed. We strongly suggest that an
amendment be made to stipulate this requirement. This will ensure that people with
hearing loss are able to understand and take part in their assessment of care and
support needs.
16
Response to the Personal Budgets guidance
11.22 We encourage local authorities to adopt suitable systems for resource
allocation to ensure that the personal budget is an appropriate amount to meet an
individual’s care and support needs. As stated in the guidance, the particular needs
of some people with hearing loss are comparatively costly to meet and a one-sizefits-all approach to resource allocation would discriminate against these clients and
other similar client groups.
Resource allocation systems often fail to meet the needs of people with hearing loss;
our 2013 research found that the resource allocation systems of fewer than half of
Adult Social Services in England allocate points for communication support needs,
meaning that people with hearing loss may not have their communication needs
met17.
11.23 It is positive to see that the personal budget will be adjusted if care and
support turns out to be more costly than anticipated at the start of the care and
support planning process.
17
Calton (2013) Life Support: The provision of social care for people with hearing loss. Available at:
www.hearingloss.org.uk/lifesupport
17
Response to the Person-centred planning guidance
We strongly support the concept of active involvement of the person throughout the
process of planning their care. For people with hearing loss to be actively involved
and engaged, they must be provided with information in accessible formats and
appropriate communication support must be provided. We have worked with Helen
Sanderson Associates to develop a number of tools for person-centred care and
care planning18. We encourage local authorities to contact us for more information.
The guidance says that it may be useful to put a review date into the care plan, but it
does not say that the local authority should do this. We believe that the guidance
should be amended to ensure that local authorities put review dates on the plan so
that care and support plans are reviewed on a regular basis.
18
More information is available on our website at: http://www.actiononhearingloss.org.uk/supportingyou/care-and-support/person-centred-working/person-centred-tools/person-centred-thinking-to-supportpeople-who-use-bsl/sorting-important-to-and-for.aspx
18
Response to the Integration & Cooperation guidance
Question 48: Are there any ways that the guidance can better support cooperation
locally?
15.22 Local authorities’ duty to cooperate with the voluntary sector as a partner
should be explicitly stated in this guidance.
15.9. During the development of their JSNA and JHWS, local authorities should
cooperate with the voluntary sector to understand the needs of particular groups,
particularly hard-to-reach populations.
15.37 People with hearing loss are particularly vulnerable to the problems resulting
from lack of integration between health and social care services given the need for
their communication needs to be recorded, understood, shared and met by all staff
and services that they come into contact with. Lack of integration can result in
communication barriers that can hinder their access to information and
communication with staff, their understanding of their condition(s), and their ability to
maintain choice and control. Improving the management of hearing loss, the
provision of information and cross-referrals, and the accessibility of services, will
reduce the problems with transition between health and care settings. This will
ultimately save money and allow people with hearing loss to live healthy,
independent lives. Our 2013 research report gives examples of how proper
diagnosis and management of hearing loss can reduce or delay the time spent in
acute care, and improve the effectiveness of rehabilitation19.
In particular, BSL users need culturally sensitive provision of care and particular
interventions and transition planning to ensure they can communicate effectively and
are not excluded or neglected during the transition between care services. These
include the proper provision of communication support such as BSL interpreters, and
access to specialist diagnostic and management tools – interventions that are not
usually available in mainstream care but which are essential for this group.
15.72 We welcome the inclusion of information and advice on housing, adaptations
to the current home, and alternative housing options services as part of the overall
service of information and advice that should be made available to residents. Our
research found that many people with hearing loss are not informed about the
adaptions that could be made to their housing to maximize their independence,
safety and wellbeing, for example the fitting of flashing smoke alarms and doorbells
and amplified telephones20.
19
Action on Hearing Loss (2013) Joining Up: Why people with hearing loss or deafness would benefit from an
integrated response to long-term conditions. Available at: www.hearingloss.org.uk/joiningup
20
RNID (2008). Annual Survey Report. Available at www.hearingloss.org.uk/supporting-you/policy-researchand-influencing/research/annual-survey-of-members/annual-survey-2008
19
15.78 It is positive to see that the information and advice available to the local
population should include information and advice on eligibility and applying for
disability benefits and other types of benefits and, on the availability of employment
support for disabled adults. Many people with hearing loss are not made aware of
the employment support that they may be eligible for, and in some cases this
prevents people from taking on or continuing work which would incur communication
support costs.
Question 56: Are there any good practice examples of local authorities working with
their partners, including health, education, employment and housing?
As mentioned above, we are concerned by the lack of strategies addressing the high
prevalence and significant impacts of hearing loss in local populations. Local
authorities should work with local health partners and the local voluntary sector to
collate comprehensive data and produce a strategic response to the needs of the
local population. An example of effective joint working to produce a detailed hearing
loss strategy can be found at: http://www.toonhearing.org.uk/files/Hartlepool-FinalReport.pdf This strategy was jointly commissioned by the Hartlepool Borough
Council and Hartlepool PCT, and summarises interviews with a range of people
working across the health and social care sectors in Hartlepool, the collation of
information from the Council’s registers and the PCT’s commissioning team, along
with a review of published literature.
20
Response to the Delayed transfers of Care regulations
Patients must have access to communication support when being assessed. Based
on our experience, delays arranging communication support have led to
unnecessary delays in transfers of care. It is therefore important that the
‘assessment notice’ (Paragraph 1(1) of Schedule 3) indicates if a patient has specific
communication needs including a need for other language support. Similarly the
carer’s assessment should also include identification of communication support
needs.
The ‘discharge notice’ (Paragraph 2(1)(b) of Schedule 3) should also identify
communication support needs, as well as identifying a need for referral for a hearing
assessment or aftercare support for patients with a hearing loss who are not
managing the condition well.
Please also refer to our response to the ‘Integration & Cooperation’ guidance.
21
Response to the Prison/Bail Premises guidance
Question 59: We would welcome views and transferable good practice examples
about the application of care and support to custodial settings, in particular about
information and advice, advocacy, financial assessment, personal budgets and joint
commissioning arrangements between custodial establishments, local authorities
and health services.
Adults in prison must not be excluded from information, prevention and care and
support services. Due to the ageing population, prevalence of hearing loss and
tinnitus is increasing in prisons and as stated in 17.1, failure to acknowledge and
address this area of need can have a significant impact on people’s health and
wellbeing as well as their longer term rehabilitation. People in or entering prison
should be supported to address and effectively manage their hearing loss.
Early intervention could delay the need for more intensive care and support in
prisons:
-
Hearing screening should be carried out, for example by including a hearing
check within the routine health assessments for those entering custody and in
prison
Hearing aids should be fitted for those who need them. Access to aftercare
and rehabilitation services (such as lipreading support) should also be
provided.
Loops and other equipment that enable people with hearing loss to
communicate should be made available in prisons
It is also vital that those who receive needs assessments while in prison have access
to communication support during the assessment to ensure that they are able to
communicate effectively during this process.
Advocacy support in prison should also consider the needs of people with hearing
loss, in particular their need to access communication support in order for them to
communicate their views and understand discussions about their circumstances.
22