The accessible information standard aims to establish a framework so patients with a disability or sensory loss can:
- Make decisions about their health and wellbeing, and about their care and treatment
- Self-manage condition
- Access services appropriately and independently
- Make choices about treatments and procedures including the provision or withholding of consent.
It applies to all NHS and social services organisations in England. Since 1 April practices have been required to identify and record the communication needs of their patients.
Practices must fully implement and conform with the standard by 31 July 2016. This article deals with the steps practices should take to ensure they provide patients with information that they can access, along with any communication support to assist them. The information below is taken from NHS England’s guidance on implementing the standard.
What do practices need to do?
Practices must provide one or more communication or contact methods that are accessible to and useable by the patient, carer or parent. The method must enable the individual to contact the practice, and staff must use this method to contact the individual.
Examples of accessible communication methods include email, text message, telephone and text relay.
Information, including correspondence and advice, must be provided in one or more accessible formats appropriate for the individual.
If your systems auto-generate correspondence it should identify a need for an alternative format and either automatically generate correspondence in that format or prompt staff to make alternative arrangements. Patients should not receive information in a standard format if this is not suitable or in line with their recorded needs.
Where needed, appropriate, professional communication support must be provided to enable individuals to effectively access or receive health care and to enable them to participate in decisions. This might involve a professional interpreter, staff modifying their behaviour and the use of aids or tools.
Practices are expected to cover the costs of meeting an individual’s information and communication support needs.
Information that supports direct patient care, for example leaflets or booklets, need to be available in accessible formats. It would be a good idea to review your most frequently used patient leaflets and make sure they are readily available in commonly used accessible formats.
The standard also suggests that organisations might want to consider the accessibility and usability of their website – but this is not an actual requirement. However, if individuals are signposted to online information as a way to meet their needs, this must be accessible to them.
Use of email and text message
Email (or text message) may serve as an alternative to telephone communication for deaf people. For blind people, email enables the recipient to use assistive technology or software, for example a ‘screen reader’, which converts text to speech or a refreshable braille display.
Depending on the software or assistive technology, a person who is blind or has some visual loss may require information emailed in one or more specific formats such as plain text (with or without attachments), HTML, and with attachments in Word or PDF format.
However, do not send emails to patients unless they have specifically consented for information to be sent in this way and have been informed of any potential risk around security
‘Large print’ information
Data coding will allow practices to record individuals’ requirements for information in ‘large print’. The codes specify font size and type of font needed - recording of a need for ‘large print’ has been deliberately avoided due to ambiguity.
Printing in a point size above 28 is generally considered impractical and patients’ needs would be better met by providing information in an alternative format, for example audio.
Communication support professionals
Where a need for support from a communication professional is identified, practices must ensure this is provided and that interpreters and other professionals are suitably skilled, experienced and qualified.
Communication professionals (including British Sign Language interpreters and deafblind manual interpreters) should have appropriate qualifications, DBS clearance and be signed up to a relevant professional code of conduct.
Communication professionals working with deaf and deafblind people should be registered with the National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD).
If it is impossible to engage an NRCPD registrant, the communication professional should hold relevant interpreting qualifications and, in the case of British Sign Language (BSL), have achieved BSL level 6.
Where health and social care staff are themselves appropriately qualified, experienced and registered as communication professionals they may take on the role of communicator or interpreter, but only with the patient, carer or parent’s explicit consent which must be clearly recorded. An independent communication professional should always be offered.
Where possible, requests from individuals for a male or female communication professional, for a particular professional and/or for the same professional should be met.
Use of family members, friends or carers as interpreters
In all instances, patients must be offered professional communication support if they need it. If a patient’s family member, friend or carer is to be used, how and when this happens must be agreed with the individual and recorded in their notes.
This preference must be regularly reviewed and also reviewed whenever a new episode of care is started or a significant decision or choice has to be made.
Communication support must enable individuals (as much as possible) to provide or withhold consent, and to make informed choices about care or treatment. NHS England guidance says practices should recognise that relying upon family members, friends or carers can be a risk. Clinicians may be unaware of the family member’s skill and ability to communicate effectively and lack of objectivity may affect accuracy and completeness of the messages conveyed.
Remote access to communication support
Practices can also access communication support remotely. This allows a three-way conversation to take place and can be accessed via a smartphone, tablet or computer, enabling quick and easy access to communication support for deaf people.
Video interpreting services should not be seen as a replacement for face-to-face interpretation/communication support, and may not be appropriate in some circumstances, especially for longer appointments.
Key word signing including Makaton
‘Key word signing systems’ are primarily used to support people with a learning disability. Two of the most commonly used, and well known, are Makaton and Signalong. This is covered by the accessible information standard.
This includes ‘translation’ of information using Makaton or another key word signing system, use of Makaton or another key word signing system as a type of ‘communication support’, and requiring a Makaton or other key word signer as a ‘communication professional’.
- Charity Mencap has produced a toolkit to help GPs make their services more accessible for patients with learning disabilities, more information here.
Exclusions from the standard
Providing foreign language interpretation or translation is not covered by the accessible information standard. However, NHS England says practices may want to record individuals’ need for official foreign language interpretation alongside recording of information and communication support needs - but this is optional.
Individuals who may have difficulty in reading or understanding information due to low literacy or a learning difficulty, such as dyslexia, are also not covered by the standard.
Resources and support
The following articles on Medeconomics contain more information on how practices can use to improve communication with certain groups of patients.
- Improving services for patients with hearing loss
- How practices can support patients with learning disabilities
- Making changes to assist your blind patients
Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member.