British Sign Language - national plan: progress report

9. Health, mental health and wellbeing

9.1 Progress in health, mental health and wellbeing

Our aspiration is for BSL users to receive the same level of healthcare and support as everyone else in society, and for health professionals using BSL to enjoy fair access to training, employment and career development. The Plan recognises that to achieve this, the use of BSL must be integrated into the health sector, and the language must be available as an option in key areas of interaction.

In 2017 the Plan called for information about health services and social care to be made available in BSL, that BSL/English interpreters should be available in health settings, and that psychological therapies should be available to BSL users on an equal basis, along with other specific actions aimed at integrating the language into the health sector's daily life. While there remains work to do before the end of the Plan period in 2023, a great deal has been achieved so far.

• Public Health Scotland (PHS) has made all screening and immunisation material accessible in BSL on the NHS Inform website.
• In 2018 and 2019, NHS24 and NHS Health Scotland (HS) worked with deaf community members to explore which health topics were important to them. In response, material about mental health, sexual health, long-term conditions, COPD, coeliac disease and chronic pain has been translated and made available in BSL.
• BSL translations of mental health and wellbeing content have been commissioned.
• QR codes on posters and letters have been used to take users directly to BSL pages on relevant websites.
• COVID-19 information has been made available in BSL when published in English.
• Communications toolkits have been developed to help staff promote BSL information, including information about coronavirus and vaccination.
• NHS HS has developed an e-learning resource to raise awareness of BSL and Deaf culture for health and social care staff.
• More than 2,400 people across Scotland have accessed a BSL and Tactile Awareness e-module since its launch in 2018.
• Progress has been made in making individual health records show when the patient's preferred language is BSL, or when a BSL interpreter is needed. By September 2019, four boards had implemented the change and seven more were working on the project.
• The contactSCOTLAND-BSL platform provides a video relay service enabling BSL signers to make telephone contact with service providers, including GPs and other health professionals.
• A new national policy has been developed to provide guidance on NHS Scotland's responsibilities in providing interpretation and translation services.
• Guidance in working with BSL users has been developed for primary care practitioners.
• Sportscotland, the national agency for sport, have made good progress scoping out a project plan, to support its delivery against the action for sport in the British Sign Language (BSL) National Plan. This included plans to develop guidance for Scottish governing bodies of sport (SGBs) to improve their engagement with BSL users in their respective sports.

9.2 Actions and outcomes

Action No. 39

Action

Publish a schedule for making all screening and immunisation information accessible in BSL. NHS Scotland will produce information in BSL to support Bowel, Breast and Cervical screening programmes. NHS Scotland will produce information in BSL to support Childhood and Seasonal Flu immunisation programmes. This information will be easy to find on the 'NHS Inform' website.

Update June 2021

Public Health Scotland has developed a schedule for all screening and immunisation materials. All screening and immunisation materials are now accessible in BSL, and will continue to be translated when materials are due for review.

Translations in BSL available on the NHS inform website

Through consultation with staff supporting BSL users, QR codes are now placed on flu posters, as well as screening and immunisation appointment letters. The QR codes take the user straight to the relevant webpage on NHS inform for information in BSL.

COVID-19 general and immunisation information was also made available in BSL very quickly on the NHS inform website.

NHS 24 have made it simple to access BSL information on NHS inform by typing 'BSL' in NHS inform search bar. This takes users to all the BSL translations available on the site. These can also be accessed using the short URL www.nhsinform.scot/bsl

The translation/format has been added to web page titles on NHS inform, so, for example, if someone searches for 'Cough' the search results will include a link to the web page with the BSL version of cough, and the name of the web page shows as 'Cough (BSL)' BSL translations can also be found on YouTube www.youtube.com/user/nhsinform

The BSL resources on NHS inform were promoted during Deaf Awareness Week and Mental Health Awareness Week, and various national events in 2019, including deafscotland's conferences: Scottish Sensory and Equality Conference and Awards (15 March 2019); BSL summit (23 September 2019) and Connect Us Too (10 October 2019). NHS 24 have also presented at various events targeting professionals who engage with BSL users, to help keep staff updated with the progress of this work, and at Deaf Action's Golden Amber club.

In February 2020, a Communications Toolkit was developed by NHS 24 to help staff from different sectors to promote the BSL information on NHS inform. This has been paused due to the pandemic and will be picked up by Summer 2021.

To help BSL users access NHS inform we have produced two video clips both available here

• 'What is NHS inform' 'What is NHS inform' is about the website, and how to navigate to the different sections
• 'Make the most of webchat' 'Make the most of webchat' explains what webchat is and how to use it.

The contact SCOTLAND-BSL logo is displayed on the 'We'll Keep You Right' pull up banners. 'We'll keep you right' is a National campaign that highlights the range of services available to help people access the right care at the right time, and where to go if you are not sure which service to access.

Since the start of the pandemic outbreak, NHS inform has been hosting extensive information about coronavirus in BSL. A toolkit explaining how people with communication differences (including BSL users) can access this information in their preferred format was disseminated to over 700 contacts. Further work is anticipated until 2023.

We would like to work with our partners at British Deaf Association (BDA), deafscotland, Deaf Action and other organisations that support BSL users to help with this. We had an opportunity to be involved in a zoom meeting in February 2021 (organised by BDA) with deaf users to answer questions about COVID-19. As a follow up BDA will be organising more zoom meetings and inviting NHS 24 and PHS to talk about wider health issues, which gives us a prime opportunity to promote the BSL translations on NHS inform website. We will also seek other opportunities like this from other partners.

Action No. 40

Action

Increase the availability of accurate and relevant health and social care information in BSL and will work with BSL users* to determine where this information should be located. NHS Health Scotland and NHS 24 will deliver this work in partnership and will review progress in 2019 and every two years thereafter.

Update June 2021

In 2018, NHS 24 and NHS HS (before PHS) engaged with over 200 deaf community members across the country to explore which health topics were important to them. These health topics were made available in BSL on NHS inform. NHS 24 presented at various events in 2018/19 targeting professionals who engage with BSL users, to help keep staff updated with the progress of this work.

In 2019 NHS 24 and NHS HS further engaged with BSL users at deafscotland's national events to explore health information needs.

As a result of this, NHS inform content about mental health, long term conditions (Diabetes, Irritable Bowel Syndrome (IBS), COPD, Coeliac disease, chronic pain), and sexual health was translated, alongside the content that regularly attracts the highest number of hits (stomach ache, sore throat, cough and flu).

Further BSL translations of mental health and wellbeing content is being commissioned. These clips are to be translated and available from May 2021.

A number of healthy living topics were also felt important to the deaf community, such as healthy eating, exercise, and self-management of health and wellbeing. Discussions are to be had between PHS and NHS 24 about which appropriate content can be translated into BSL, which will be available on NHS inform website.

NHS 24 Digital Team have agreed a process for linking to quality-assured BSL clips from the NHS inform You Tube channel (effectively creating a BSL hub on You Tube). Researching such resources and engaging with the organisations that developed them has not be possible due to other work priorities. Linking to other trusted organisations and maintaining updates of BSL translations are to be further explored.

Action No. 41

Action

Work with local authorities, providers and service users to improve the way that adult social care is delivered, including how residential care is commissioned and how care and support is delivered to people at home. The voices and experiences of service users, including BSL users* will be at the centre of these reforms and will shape planning and implementation and improve outcomes.

Update June 2021

Before the pandemic began, PHS had been working with a wide range of partners including people who use social care support, COSLA, unpaid carers, the social care sector and others to develop a reform programme for adult social care.

This work identified a number of priorities where we needed to work together to support change and improvement including how social care is understood and valued by individuals and society, how it is funded and paid for into the future, what models of care we need in Scotland and how they are delivered, and how we achieve Fair Work for our vital social care workforce.

While much of that work was paused due to the pandemic and the independent review of adult social care we remain committed to co-production and ensuring that those who use, or who may need, adult social care are at the heart of developing new approaches for the future.

In the past year we have worked co-productively with Social Work Scotland, COSLA, partners, stakeholders and service users on the development of a Self-Directed Support Framework of standards that incorporates the principles of a human rights approach and consideration of consistent implementation nationwide. The Framework sets out the actions that public and voluntary organisations would take to support authorities to build on their progress towards more flexible and responsive social care support, co-produced with communities and supported people and to ensure that personal outcomes are agreed on the basis of what matters to the person.

The Framework and standards also incorporate the need for independent support and advice, all of which has been recognised within the Independent Review of Adult Social Care (IRASC).

Action No. 42

Action

Take forward the work to extend free personal care to everyone who requires it, regardless of age, taking account of the views and needs of BSL users*.

Update June 2021

The Independent Review of Adult Social Care in Scotland recommended the removal of non-residential charges for adult social care. Work to examine how this could be achieved began in April 2021 and with the aim of providing options for the Scottish Government.

Action No. 43

Action

Develop a learning resource for health and social care staff to raise awareness of BSL and Deaf culture. This will be led by NHS Health Scotland and will be rolled out across Scotland by 2018.

Update June 2021

NHS Health Scotland completed this action and developed an e-learning resource for health and social care staff to raise awareness of BSL and Deaf culture. This was done in partnership with BSL users, colleagues from: deafscotland, Deafblind Scotland, Care Inspectorate, Scottish Social Services Council, NHS Education Scotland, NHS Lothian and NHS Forth Valley.

The e-module 'British Sign Language (BSL) and Tactile BSL awareness' was launched in September 2018, and has had over 1,400 people complete the course, with over 2,400 accessing the course in Scotland. This e-module can be accessed here.

NHS Health Scotland also collaborated with NES and Talking Mats to update the 'Making Communication Even Better' learning resource, reflecting the needs of BSL users, which was launched in September 2020.

The module has been promoted via the partners involved in the development and continues to be cascaded through NHS Scotland boards. The module is also hosted on 8 NHS Board websites, 2 Local Authority websites, and 2 Higher Education websites.

Action No. 44

Action

We will agree how to improve individual patient health records so that they clearly show when the first or preferred language is BSL and a BSL/English interpreter is needed. NHS services can then be notified in advance of any appointments.

Update June 2021

Following a pilot by NHS Lothian and Edinburgh University (ANDI project), a letter was issued by the Scottish Government's eHealth lead, to all NHS Boards for implementation in Jan 2019, with agreed support from National Services Scotland (NSS). Progress was mixed in implementing the changes in 2019, the main part of which is to implement a referral flag in SCI Gateway and linkages to GP systems. PHS proposed an audit of the patient information system across early adopters to assess impact on service provision, and potentially on people who did not attend an appointment.

By September 2019, PHS gathered information on this:

• 4 boards had fully implemented the change
• 3 boards were in progress and expect to be fully implemented by end of September 2019
• 4 boards were working on the project but had no end date identified – mainly due to it not being an identified issue for them currently and therefore not being prioritised over other priority projects
• 7 boards reported it was not applicable to them (national boards)
• 4 boards were still in the process of responding with an update.

This work was paused due to work priorities and COVID-19, and PHS will explore with NSS and wider partners any progression made in the light of COVID-19. PHS is also keen to continue conversations with SG on any development and future of this work.

Action No. 45

Action

Ensure that – in line with Scotland's Mental Health Strategy 2017-2027 – BSL users* should get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma.

By 2020: a) NHS Boards and Integration Authorities should take action so that psychological therapies can be offered on a fair and equal basis to BSL users*. b) NHS 24 and NHS Health Scotland will develop information about mental health accessible for BSL users* through 'NHS Inform'. c) NHS 24 will explore how telemedicine initiatives like 'Breathing Space' can provide counselling in BSL as an easy-to-access mental health support.

Update June 2021

BSL users can utilise the contactSCOTLAND-BSL is a platform to make initial contact for mental health services, and once in the system, the clinician/administrator would set up a BSL interpreter for appointments.

Telephone interpreting and the Near Me (the commonly used video consultation platform) are both available through the internal NHSLan intranet request mechanism. There is also an "interpreting on wheels" service that can be called into hospital sites and the Out of Hours (OOH) centre.

This work was paused due to work priorities and COVID-19, and PHS will explore with NSS and wider partners any progress made in the light of COVID-19. PHS is also keen to continue conversations with SG on any development and future of this work.

Action No. 46

Action

Implement a new national Interpretation and Translation Policy which includes BSL provision. This will be led by NHS Health Scotland and will provide guidance to support delivery across all NHS boards by 2018.

Update June 2021

A NHS Scotland Interpreting, Communication Support and Translation National Policy was developed to provide guidance on NHS Scotland responsibilities to patients and carers who require support from interpreting or translation services. The Policy was developed in collaboration with 10 NHS Boards in Scotland. A competency framework was also developed by PHS to support implementation of the above policy. Furthermore, PHS developed guidance for working with BSL users in primary care to improve access and support effective communication. The three resources above were promoted to health professionals in the NHS, Scottish Government, National Partners and Networks, and third sector organisations via emails and social media. Examples include, HSC ALLIANCE, CHEX, Inclusion Scotland, BDA, COSLA, deafscotland, DeafBlind Scotland, Royal College of GPs, NHS Equality and Diversity Leads.

PHS attended a 'National Deaf Children's Society' webinar to present and promote the three national resources (October 2020).

Action No. 47

Action

Work with partners to deliver and evaluate two training programmes aimed at supporting BSL/English interpreters to work within the Health sector, with a view to informing a longer-term approach.

Update June 2021

Applications were opened in June 2018 for the UK's first fully online Master's Degree designed to upskill British Sign Language (BSL)/English interpreters. The newly validated MSc in BSL/English Interpreting at Queen Margaret University, Edinburgh is the only post registration master's in the UK to focus on BSL interpreting, and the only academic course delivered online for registered sign language interpreters.

Action No. 48

Action

Work with sport governing bodies and with 'sportscotland' to improve access to information and sporting opportunities for BSL users*.

Update June 2021

The Scottish Government has been investing in a consortium of organisations to support public bodies to implement the actions in the National Plan. Prior to the COVID-19 pandemic, sportscotland, the national agency for sport, made good progress scoping out a project plan, to support its delivery against the action for sport in the British Sign Language (BSL) National Plan. This included plans to develop guidance for Scottish governing bodies of sport (SGBs) to improve their engagement with BSL users in their respective sports.

In October 2019, sportscotland delivered a BSL consultation session at the annual SGB Equalities Conference. The consultation was delivered through three workshops, focused on raising awareness, developing understanding and identifying what support SGBs need to improve access to information and opportunities for BSL users. 36 SGBs attended this conference and all attended the BSL workshops. Feedback was gathered and key actions identified.

However, due to the COVID-19 pandemic and associated challenges and constraints faced by the sporting sector, progress against this action was put on hold. When the time is right, further engagement with SGBs will take place to further develop sporting opportunities for BSL users.

Action No. 49

Action

Ensure that the national strategy to address social isolation and loneliness which will be published for consultation in Autumn 2017 will make explicit reference to the experience and needs of BSL users*.

Update June 2021

Scottish Government published 'A Connected Scotland' in December 2018 which stated that; "Through the BSL (British Sign Language) National Plan 2017-2023, we are committed to ensuring that D/deaf and Deafblind BSL users can be fully involved in daily and public life in Scotland, as active, healthy citizens". The delivery plan for the strategy has not been published as a result of work pivoting towards the pandemic response, however our intersectional approach to tackling inequalities that lead to social isolation and loneliness remains.