Select Committee on Work and Pensions Minutes of Evidence


Memorandum submitted by the Royal National Institute for Deaf People (RNID) (MS 07)


  1.  In October 2001 RNID published Can't Hear, Can't Benefit: A survey of deaf people's experiences of claiming Disability Living Allowance. The survey was conducted between September and August 2000 and included a number of questions on medical assessments. 271 respondents in the sample had been assessed by an examining medical practitioner (EMP). The key findings on medical assessments were:

    —  76 per cent of examinees said it was difficult to communicate with the doctor.

    —  40 per cent of those who had undergone a medical assessment said they were dissatisfied with the doctor's visit.

    —  One in five examinees (21 per cent) said that the doctor did not ask them about their communication needs.

    —  30 per cent of examinees said that the doctor did not seem to understand deafness. One in twelve examinees (9 per cent) said that the doctor was rude.

    —  Over one in eight examinees (13 per cent) said that communication support was needed but had not been provided.

    —  Nearly two-thirds of examinees (63 per cent) were not informed that they had a right to communication support during the assessment.

  2.  The satisfaction levels amongst deaf claimants in the sample appear to be substantially lower than those recorded in the Government's own customer surveys. In its reply to the Social Security Committee's report on Medical Services the Government said that 77 per cent of customers were satisfied with medical assessments in DLA.[10] In March 2001 DSS officials told the Public Accounts Committee that recent customer surveys had shown satisfaction rates of 92-93 per cent.[11]

  3.  Respondents were asked why they were dissatisfied with the doctor's visit. The most common complaint, cited by nearly three-quarters of those dissatisfied (74 per cent), was that the doctor did not appear to understand deafness. 9 per cent said the doctor was rude, which also seems to indicate a lack of deaf awareness on the part of the doctor. Also alarming was the finding that over one in five deaf examinees (21 per cent) said that they not been asked about their communication needs. As deaf people qualify for DLA precisely on account of their communication needs, the failure to ask about these needs effectively renders these assessments incomplete.

  4.  Examinees were also asked if they had experienced problems communicating with the examining doctor. Three-quarters of examinees (76 per cent) found it difficult to communicate with the doctor. Although 13 per cent of examinees cited non-provision of communication support as the reason for their dissatisfaction with the doctor, the fact that the overwhelming majority of deaf examinees found it difficult to communicate with the doctor suggests that the failure to arrange communication support is a more widespread problem.

  5.  It is DWP policy to provide interpreters for deaf people during medical assessments. However, 63 per cent of those assessed by a Medical Services doctor were not informed that they had a right to communication support during the assessment. This may be due to the fact that, before 2001, the notification letters did not advise deaf claimants of their right to an interpreter. The current notification letter says "We will provide an interpreter if required—or you may wish to arrange for a friend or family member to interpret for you"[12] However, this still puts the onus on the claimant to request communication support and also allows for the use of non-professional interpreters who may not be qualified to interpret accurately during medical assessments.

  6.  Evidence provided to the National Audit Office showed that 12 per cent of examining medical practitioner visits during 2000, which were almost exclusively carried out for DLA and AA, were deemed not "fit for purpose".[13] The findings in the RNID survey suggest that many deaf claimants are undergoing medical assessments that should have been classified as unacceptable because interpreter support was not provided or their communication needs were not properly assessed.

  7.  The fact that so many examinees reported difficulties communicating with examining doctors suggests that the Medical Services policy on communication support needs to be reviewed. Accurate sign language interpretation during a medical assessment is difficult for informal or unqualified interpreters because medical and technical terminology cannot be easily translated from English to British Sign Language (BSL). Only registered qualified signed language interpreters can guarantee an accurate standard of interpreting.

  8.  The level of dissatisfaction with medical assessments amongst deaf respondents is unacceptably high. It is alarming that 31 per cent of examinees in the sample felt the doctor did not understand deafness. However, lack of deaf awareness may only be part of the reason that 21 per cent of examinees complained that the doctor did not ask them about their communication needs. The medical report forms used in the assessment are inadequate because they do not direct doctors to ask the right questions about communication needs. As with the guidance to decision makers the report forms do not reflect developments in the case law on sensory impairment.


  9.  In our Can't Hear, Can't Benefit report RNID recommended the following steps to improve the quality of medical assessments for deaf people:

    —  Deaf awareness training should become a core element of training for Medical Services' doctors.

    —  Medical assessments should only be carried out using professional communication services not informal interpreters.

    —  The DWP should develop deaf-specific questionnaires for use by examining doctors.

    —  If a deaf claimant undergoes a medical assessment without the requisite communication support the case should be sent back to Medical Services for re-examination.


  10.  Since the launch of our DLA report, SchlumbergerSema has been very willing to listen to RNID's specific concerns. In February 2002 representatives from RNID met officials from DWP, Corporate Medical Group, SchlumbergerSema, and the Appeals Service, to discuss the report. SchlumbergerSema has now developed a half-day sensory impairment training module which will be rolled-out to all doctors over the next year. RNID was consulted over the design of this training module and would like to see this welcome initiative form part of the core induction training for all new doctors.

  11.  Despite SchlumbergerSema evident desire to improve the service to deaf people, RNID is still very concerned that deaf sign language users continue to undergo medical assessments without professional interpreters. We strongly recommend that Medical Services' policy on interpreters is revised so that informal or unqualified interpreters are no longer used. We would also like to see training and guidance for staff arranging medical assessments so that they are better equipped to understand deaf people's communication needs and the types of communication services available. For example, a deaf person whose preferred method of communication is English may require a lipspeaker or palantypist.

  12.  RNID would like to see a mechanism for returning cases for re-examination of deaf people if interpreters have not been provided at the first assessment. We recognise that this may not be easy to implement, as the need for, or absence of an interpreter may not be recorded in the medical report. We suggest that specific guidance is prepared for DWP decision makers and Medical Services staff on how medical assessments for deaf claimants should be conducted.

Duleep Allirajah

Welfare Benefits Policy Officer

4 April 2002

10   Report on Medical Services: Reply by the Government to the Third Report of the Select Committee on Social Security Session 1999-2000 [HC 183], DSS, Cm 4780. Back

11   Committee of Public Accounts, Minutes of Evidence, 21 March 2001, The medical assessment of incapacity and disability benefits, HC 366. Back

12   Medical Services leaflet AL1C (DV) Important information about your medical examination. Back

13   The Medical Assessment of Incapacity and Disability Benefits, National Audit Office, HC 280, March 2001.


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