This chapter should be read in conjunction with the following chapters: Children and Young People with Complex Needs; Older People; Healthy Lifestyles and Long Term Conditions; Physical Disability
Recommendations
All agencies, in partnership, to:
- Increase awareness of specialist and support services to improve signposting (273);
and improve joined working - Promote awareness and normalisation of British Sign Language (BSL)
- Anticipate the increase in prevalence of hearing and sight loss in the future
- Increase opportunities for consultation and co-production
- Sign up to the Disability Confident Scheme (200) and develop inclusive recruitment.
The D/deaf community (encompassing people who have profound hearing loss and
use BSL (Deaf), as well as people who have hearing loss (deaf)) need more D/deaf
and BSL users professionals embedded in services to ensure they are represented
and that communication is not a barrier
Cardiff and Vale University Health Board and Cardiff and the Vale of Glamorgan Local
Authorities to: - Undertake Deaf Awareness training for staff to improve the culture for service users, and co-workers who may have hearing loss
- Increase the number of Rehabilitation Officers for Visually Impaired people in line with recommendations (274)
- Design physical activity strategies and plans to increase D/deaf-friendly and D/deaf aware opportunities
Cardiff and Vale University Health Board and Primary Care to: - Improve recording of Deaf people as Deaf in medical records so BSL interpreters can be appropriately booked (273), improving referrals, and experience of health care
- Take additional action to promote equity of access to healthcare services for D/deaf people compared to non-disabled people
- Support the newly established Inclusive Recruitment Team who ensure that they work to the Themes and Goals of the Disability Confident Scheme
Overview
The All Wales Standards uses the term “people with sensory loss” to describe:
- People who are Deaf, deafened, or hard of hearing
- People who are Blind or partially sighted
- People who are Deafblind (whose sight and hearing impairment cause difficulties with communication, access to information, and mobility (275)
Sight loss
There are an estimated 9,530 with sight loss in Cardiff, and 4,790 in the Vale of Glamorgan in 2021, giving a prevalence of 2.6% and 3.6% (prevalence in Wales: 3.5%). Of these, 1,240 and 640 people in Cardiff and the Vale of Glamorgan respectively have severe sight loss (blindness). In Cardiff, there are 40 children aged 0-16 who are blind, and 10 in the Vale of Glamorgan. Half of children who are blind or partially sighted have additional disabilities (276). People with learning disabilities are 10 times more likely to have sight loss than those without learning disabilities (276).
Hearing impairment
Documents use different terminology; this chapter aligns with that used by the All Wales Deaf Mental Health & Well-Being Group. Where specifically stated, people who identify as members of the Deaf community, who have profound hearing loss and use British Sign Language (BSL), are described as Deaf; whereas those with hearing loss or where it is not specified, the terminology “deaf” is used (273). Where both communities are described, “D/deaf” is used.
In Cardiff, 29,800 people are estimated to have moderate/severe hearing loss; this figure is 15,500 for the Vale of Glamorgan. A further 660 people (Cardiff) and 340 (Vale of Glamorgan) have profound hearing loss, including 95 people of working age (20-64 years) (276).
Dual sensory impairment
The Royal National Institute of Blind people (RNIB) estimates that 21,300 people in Wales have any dual sensory impairment, of whom 1,860 live in Cardiff, and 910 in the Vale of Glamorgan (276).
This chapter was developed using existing literature, strategies and reports and triangulating findings with professional leads and engagement work: 38 survey respondents, 6 participants for the sight loss focus group, and 4 participants for the Deaf focus group, which was conducted in BSL. Forty-nine respondents of the provider’s survey provided services for people with sensory loss or impairment. The views of those engaged are not representative of all people with sensory loss or impairment in the population of Cardiff and the Vale of Glamorgan.
What has changed since 2017
Pre-COVID-19
Welsh Government published the ‘Framework of Action for Wales 2017-2020’ which details the integrated framework of care and support for people who are D/deaf or living with hearing loss (277). The All Wales Deaf Mental Health & Well-being Group published their report on the hidden inequalities around mental and physical health amongst Deaf people in 2021 (273). Professional leads observed an increasing awareness of the existence and importance of intersectionality, which describes the “complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect especially in the experiences of marginalized individuals or groups” (278).
Cardiff and Vale UHB is now the first Welsh Health Board to sign the British Deaf Association’s British Sign Language Charter (279). The Health Board was highly commended by the Health Service Journal for transforming glaucoma eye care services in 2020/21 (280).
COVID-19
Independence and isolation
The Welsh Government published ‘Locked out: liberating disabled people’s lives and rights in Wales beyond COVID-19’ in 2021. This report identifies difficulties disabled people have experienced during the COVID-19 pandemic, and states that people with visual loss have had their autonomy and mobility negatively impacted due to structural changes in the environment and learned routes. For example, new layouts in the town centre and changes to access to sighted guides (79).
The Royal National Institute for Deaf People (RNID) report that deaf people in the UK experienced increased isolation through reduced social interaction, masks, and social distancing; and that non-face to face options such as telephone contact weren’t always suitable (281). Sight Cymru stopped in-person groups in 2020 but maintained contact through virtual meetings and phone calls. The RNIB’s research across the UK finds that people with sight loss considered technology a “saviour” (282); which was echoed in the PNA focus groups: “I was stuck at home. Zoom has been very good. Without Zoom we’d all be lost”. However, people felt “more disabled” and as though their world has “shrunk” (282). Focus group participants discussed the difficulties of not being able to visit family members in hospital.
D/deaf focus group participants stated that as communication with D/deaf peers and friends is so important for well-being, the lockdowns restricted this and created a sense of isolation. This isolation impacted negatively on participants’ mental health. The D/deaf community relied more on online resources despite it being difficult with BSL interpreters on online platforms
Eight of 38 survey respondents with sensory loss reported that before COVID-19, they felt lonely some of the time, with 1 respondent feeling lonely all or most of the time. Over the last year, however, 18 feel lonely some or all of the time.
Access to public health information
Nationally, deficiencies in accessibility of public health information were observed, through lack of subtitles for audio content; lack of BSL versions of critical information; and a reliance on telephone hotlines (79) (281). The RNID polled its UK members regarding awareness of a video relay of Test and Trace, but 94% were not aware of this. Insufficient notice for key government announcements and a lack of BSL translation meant information was inaccessible to people with hearing loss. A new government role has been developed to lead on accessible communications from UK Government (281). People with visual impairment may be unable to adhere to social distancing rules, and have subsequently experienced negative reactions from others; as well as being at increased risk of COVID-19 (282).
The focus group reported a lack of information on the pandemic and lockdown provided for the D/deaf community, so news often came from social media. Lots of D/deaf people struggle with written English and need BSL resources. The British D/deaf Association set up a daily BSL news summary specifically for the D/deaf community, which reduced isolation and panic: “I would have been lost without them”.
Access to health and care services
In the UK, around half of people with hearing loss reported a negative impact of COVID-19 on access to care services, compared to one-sixth of people without an impairment (281). A survey amongst RNIB members puts this figure at 73%, with 4/10 concerned that their vision would worsen (79). Support provision and consultations provided over the phone or virtually provoked difficulties for people who are Deaf or hard of hearing, as they often use visual cues or lip reading. Masks also prohibit lip reading; therefore, face to face appointments were also difficult as people did not feel able to ask staff to remove their masks (281). Transparent masks have now been approved. Online technologies are not a “Support groups are usually only in English. Some peoplehave been prevented from attending as they are not able
to speak English” – person with sight loss, focus group direct replacement for face to face services, and many people who are deaf or visually impaired struggled to access virtual services (283); stating that 50% of communication is lost through a webcam (273). Cardiff and Vale UHB provided iPads to enable person-centred care, and to overcome the assumption that everyone has access to digital technology.
The RNID reports that deaf people who were shielding could only register for priority supermarket deliveries via telephone (281); similarly, people with visual loss experienced problems with accessing services in Wales (79). A higher proportion of disabled people experienced difficulties accessing essential products such as food and medication compared to non-disabled people (50% versus 17%) (281). One-fifth of respondents in RNIB research in the UK rationed food due to concerns regarding food deliveries (282). Those assisting deaf people were exempt from wearing a face mask, to aid communication, however as deafness is a hidden impairment, many people were concerned for stigma and negative reactions by others (281).
Participants in the sight loss focus groups discussed that many services had stopped due to COVID-19 restrictions; but that online support such as through third sector organisations, groups, and clubs have been very helpful.
Cardiff and Vale UHB developed videos with subtitles, communication flash cards and provided accessible information regarding vaccinations (280).
Education and employment
COVID-related adjustments in the workplace may make it more difficult for D/deaf people to return to work, for example, through physical barriers between workspaces, face masks, and social distancing. For those working from home, the increased reliance on video and audio calls may present a barrier (281).
The National Deaf Children’s Society report that children and their families are concerned regarding the lack of specialist support for their education, difficulties accessing online learning platforms, as well as difficulties communicating due to face masks in schools (284).
What are the care and support needs?
Individual
Independence and autonomy
Funds are now available in Wales for disabled people who would like to stand in local government elections, to cover costs such as travel and assistive technology (285). Increasing visibility of disabled people – including sensory loss – will help create an inclusive environment.
A focus group with D/deaf participants articulated that services are not always accessible to D/deaf users: many services (particularly medical) rely on the phone which is a barrier for the D/deaf community. D/deaf service users often have to rely on hearing family members to make phone calls and contact services on their behalf, affecting independence. They would like to see more D/deaf community groups and centres where the community come together and gain support; and activities which are accessible.
Participants recalled there used to be specialist D/deaf social workers, but this service was replaced with general social workers who “don’t live a D/deaf life”, and “provide help that they think you want rather than asking what help you really want”. This additionally emphasises the importance of person-centred services. Due to a lack of knowledge of the D/deaf community, there was poor signposting to services.
Physical and mental health
There is a synergy between sensory impairment and other medical conditions. For example, people living with dementia have increased prevalence of sight loss; dementia can make it more challenging to diagnose sight loss (276). Deaf people are more than twice as likely to experience mental health disorders, such as anxiety and depression than hearing counterparts; this is in part due to their experiences of stress, discrimination, and isolation (273). COVID-19 has further exacerbated these inequalities (273). Deaf people report that they are not recorded as Deaf in their GP records, which has consequences for any
subsequent referrals. Negative experiences lead to Deaf people disengaging from health care services (273).
Children and young people
In Wales, most (80%) school aged deaf children attend mainstream schools without specialist provision; with others attending mainstream schools with resource provision (9%), special schools not specifically for deaf children (10%), or undertaking home education (1%) (273). Nearly half of Teachers of the Deaf in Wales will likely retire in the coming 15 years (273).
Focus group participants stated that D/deaf children are not able to create a D/deaf identity, integrate into the D/deaf community, or form close connections with other D/deaf children/people without specialist D/deaf schools. Parents need to learn BSL, as do teachers and support staff – support staff are often not specialist or D/deaf themselves. There are a lack of D/deaf youth groups to bring D/deaf young people together to help create that identity. This lack of community for young D/deaf people makes it difficult for them to find out about services or access support, which leads to isolation and mental ill health.
Language and communication
Since 2004, BSL has been a recognised official language in Wales, with 4000 speakers in Wales (273). However, there are only 48 BSL/English interpreters with the relevant qualifications in Wales, below the target of 64 (273). Although interpreters can be booked for planned meetings, more spontaneous communication in healthcare settings (such as during an inpatient stay) is challenging (273). There are no mental health practitioners in Wales with Welsh BSL, limiting culturally appropriate care for Deaf patients with mental health problems (273).
Access to information for Deaf people on how to book a BSL/English interpreter is also limited, often health care providers are not knowledgeable about the process, and confirmation that an interpreter will be present for an appointment is often lacking (273). Welsh language information is proactively offered, but people report needing to ask specifically for BSL (273). Focus group participants with sight loss experienced similar barriers to access due to support provision available only in English.
Cardiff and Vale UHB has used funds from the Patient Experience Team to give staff the opportunity to learn BSL; some staff went to additional classes external to the Health Board. BSL information videos are now played on all hospital screens (280).
Focus group participants stated communication between D/deaf services providers and D/deaf service users is poor. There is a general lack of D/deaf awareness among the hearing community, and so organisations need more training and awareness. There needs to be easier ways to communicate with services, without relying on telephones, such as email or preferably a BSL speaker on video. Many native BSL users do not read or write in English. In many cases the D/deaf community just give up trying to access services. There is a need to employ more D/deaf people/native BSL users to embed the D/deaf community within service provision.
Community
Wider determinants of health
Deprivation
The ‘Locked Out’ report includes people with sensory loss, and describes how disabled people are more likely to live in poverty and in more deprived areas than non-disabled people. This has been further exacerbated by the coronavirus pandemic (79).
The RNIB reports that only one in four blind and partially sighted people of working age are in employment. Local authority level data are not available. People who live in more deprived areas are at increased risk of sight loss (276); as are people on low incomes, with explanations including concerns regarding the cost of glasses or barriers to accessing optician or ophthalmic services resulting in people delaying appointments until they have symptoms (286).
Housing
Professional leads identified the need for statutory bodies, third sector organisations, and housing associations to collaborate better in order to build or adapt houses suitable for people with hearing or sight loss, for example, induction loops. This is equally the case in residential homes and the workplace. The planned new hospital in Cardiff will have induction loops built in, which will help normalise reasonable adjustments. Concerns raised by focus group participants with sight loss included receiving sufficient care for them to stay in their own house in the future.
Unmet needs
Access to health services
A report investigating inequalities for Deaf people in Wales noted that there are no formal links between Deaf Child and Adolescent Mental Health Services (CAMHS) in Wales and the equivalent in the UK; whereas there are such arrangements between hearing services for CAMHS (273). There are ten National Deaf CAMHS centres in the UK, of which none are in Wales. The report identifies that 40% of Deaf people have mental health concerns, and estimates that around 1,000 of the 2,500 Deaf children and young people in Wales are at risk of mental health problems (273). Deaf CAMHS offer specialised services, including consultations in BSL. Often Deaf adult patients requiring inpatient admissions are
transferred to England (273).
The sight loss focus group identified difficulties accessing health and social care services: “it is very difficult to see a doctor physically…. I have to wait on the phone to get through for a very long time”; “GPs should know where to refer us for extra support. They don’t know. Social Services should be there for help, support and advice.” The D/deaf focus group articulated accessibility barriers to accessing support services, such as relying on phone calls to access services. Some GP services offer a signed video service, but not all. Most rely on a phone line to make appointments so D/deaf users have to go into the surgery to make an appointment or ask a hearing family member.
There is no specialist mental health provision for D/deaf people, making access to mental
health services very difficult. The participants would like to access fitness/health activities such as yoga or a gym, but these activities/organisations are not D/deaf friendly and very few staff/instructors are D/deaf aware. Public facing organisations and activities such as yoga/gyms need more D/deaf awareness to make access easier, such as through employing D/deaf people. The focus group with D/deaf people articulated a real feeling that services had been cut, for example, funding for a D/deaf centre which has since been closed. The discussion included that comparatively small amounts of funding could be transformational, but are currently inaccessible.
Data gaps were identified around deprivation levels and sensory loss; and people with sight or hearing loss and other medical conditions.
What are the range and level of services needed?
Prevention and assets
Newborn hearing screening
In Cardiff and Vale UHB, 99.9% of eligible and suitable babies are offered hearing screening, and 99.2% undergo newborn hearing screening (287). Of high risk babies referred, the average age of confirmation of hearing loss was 7.3 weeks (Wales average is 7.4 weeks) (287). Average age at hearing aid fitting was 13.7 weeks (Wales average 11.4 weeks) (287) Vision screening is assessed at multiple times during childhood (288).
Rehabilitation Officers for Visually Impaired people
The Wales Council of the Blind, in collaboration with other organisations, has reported that currently the number of Rehabilitation Officers for Visually Impaired people (ROVIs) is insufficient to meet need; and warn that this situation will escalate in coming years due to the anticipated increase in blind and partially sighted people (274). Furthermore, there are limited training places and existing ROVIs are due to retire, limiting capacity for future demand.
ROVIs are considered essential under the Social Services and Well-being (Wales) Act 2014 for their role in prevention, and minimising the impact of impairment. People with a new diagnosis of sight loss receive help from ROVIs to conduct activities of daily living; and learn how to minimise risk of injury. Furthermore, ROVIs build confidence, promote independence, and provide practical and emotional support (274). ROVIs enable people with sight loss to be active citizens in society, and live safely (289). Rehabilitation
interventions facilitated by ROVIs can provide cost benefits to health and social care services (289).
A 2021 report by Wales Council of the Blind (289) identified, at a Wales-wide level, concerns regarding a future workforce crisis; including the risks of task-shifting from qualified ROVIs to staff members who have not received the necessary training, which may negatively impact services received by people with sight loss. Additional concerns across Wales include variation in referral mechanisms; concerns people are signposted away from ROVI services; and suboptimal supervision of ROVIs. There are plans to regulate the profession under the Professional Standards Authority. The report recommends recognition by Social Care Wales and to encourage the standards to be adopted by each local authority, as well as improving
public understanding of the role of the ROVI. Other recommendations include development
of a clear pathway into ROVI services and signposting to other agencies for input that cannot be provided by a ROVI (289).
In 2020, there was only 1 ROVI in Cardiff, and 1 in the Vale of Glamorgan, which is far below the minimum standard of 1:70,000 population (equating to 5.2 in Cardiff, and 1.9 in Vale of Glamorgan) (274). However, theme leads have identified that the ROVI waiting list in Cardiff and the Vale of Glamorgan is manageable, and Sight Cymru provide additional support which is beneficial for service users.
Falls prevention
Sight loss can lead to falls; the RNIB estimate that 540 falls in Cardiff and 290 in the Vale of Glamorgan amongst people aged 65 and over are directly attributable to sight loss (276). Prevention of sight loss, or appropriate management where possible, may help reduce the risk of falls. The National Institute of Health and Care Excellence (NICE) recommend that vision assessment and referral are carried out within a multifactorial intervention for people who are at risk of falls or who have fallen (290). This guidance has been incorporated into the Cardiff and Vale UHB Falls Framework (291).
Supportive environment and awareness
The Framework for Action calls for an environment that removes barriers and enables people to reach their full potential; and reduces inequalities (277). Co-production is one mechanism by which to enable people with sensory loss to collaborate with health and social care professionals, and the third sector (277).
One survey participant articulated the need for wider societal understanding of hidden disabilities as she was concerned regarding her mobility and potentially falling over; and demonstrates the impact of others’ actions on their independence and confidence.
The D/deaf community face inequalities from the wider community caused by physical barriers to communication rather than wider stigma or fear. Addressing these practical communication barriers is easier than changing mindsets. One participant worked within the hearing community and felt discriminated against, and so moved jobs to work with the D/deaf community where she felt more comfortable.
The D/deaf focus group highlighted a “pushback” after disclosing their D/deaf status. This was thought to be not due to stigma but a lack of awareness of D/deaf needs. This pushback discouraged the D/deaf community from seeking to access some non-essential services. Focus group participants felt D/deaf awareness is not sufficient among service providers and so services are generally inadequate for the D/deaf community. D/deaf people are not represented enough among decision makers and so policies are made by hearing people without
understanding the needs and lived experience of the D/deaf community. Education to the wider population and service providers, and improving and increasing understanding would be the most important contributor to removal of barriers.
Assets to support well-being
A number of assets that support people’s well-being were identified. People with sight loss reported that despite lockdown restrictions, they were positive about support from the third sector: “Age Alive and Sightlife meetings have been great [online]…[online] support groups run by the organisations have enabled us to socialise during lockdown”; and “Sight Cymru gave me so much support. Without them no-one would have told me anything”. One respondent wanted more support closer to home, as “everything seems to be in the town centre”.
D/deaf focus group participants reported that
D/deaf peers and friends are crucial to well-being
and to support good mental health. Without regularly meeting with D/deaf friends one
participant said that she would have become
depressed and unwell. It is important to
communicate with others who understand the
D/deaf experience. With a lack of awareness
among the hearing community, the D/deaf
community is crucial to forming a D/deaf identity
and to sharing information on services.
One
participant, previously a board member of a local
D/deaf charity, has set up a D/deaf group of their own. The services that the group values were D/deaf originated – often in a response to what they felt were historic local authority cuts. These groups were seen as being a key part in meeting Future Generations obligations (especially around early intervention) and Local Authority Equality Requirements, but there were funding difficulties. The Royal Association for the D/deaf was also helpful. Survey respondents with sensory impairment reported that the church was a good source of support, alongside third sector and community groups (such as Friends of the Library; Gyspy Travellers Wales; Women Connect First; Sight Life Cymru; Women’s Institute), and socialising over food and drink in cafes and restaurants or virtually. Barriers to accessing these assets included transport; and closure of groups and venues due to COVID-19 restrictions. Professional leads identified Deaf Hub Wales and the RNIB as useful assets locally.
Community Services
Health services
The Framework for Action states that people with sensory loss should be signposted in a timely manner to specialist services as appropriate, including speech and language therapists and counselling services (277). Young people in particular should have a seamless and timely transition to adult services (277).
Cardiff and Vale UHB has developed a phone first
system to access Emergency Care. The service is
also available via Textphone (for deaf or hard of
hearing patients); or through Relay UK (for
patients who are deaf, hard of hearing, or speech
impaired) (280). Focus group participants wanted to see their GP and other healthcare specialists face to face, and for the process to be easier and quicker. Care and support services should align with transport needs to ensure access for service users.
Social Care
Sight loss focus group participants wanted social workers or support workers to provide information and advice; help with forms; and emotional support. Specialist D/deaf social workers are also desirable, similar to previous provision, to help support D/deaf people by drawing on lived experience.
Education and employment
Support for people with hearing or sight loss to
seek, gain, and thrive in employment has been
discussed by professional leads. Fear of losing a
job and stigma means people can be unwilling to
declare their need for hearing aids. Employers can
proactively inform prospective and current
employees of support available for people with
hearing or sight loss. Initiatives to achieve this
include disability confident and inclusive
recruitment, with added benefits of drawing from
a wider pool of talent, and improving staff morale
through evident support (200). Reasonable
adjustments and adaptations, such as hearing
loops, will help people with hearing impairment.
Partnership approach
Person-centred services
Services need to be person-centred, so that the individual is able to do what matters to them. In line with this, independence should be promoted: “One of my fears is how do we keep our independence? Plus who do we go to for help?”
Some focus group participants commented that services were “all or nothing”, for example regarding transport: “I don’t qualify, it’s very black and white, there seems to be no inbetween” (sight loss focus group participant). Others commented that “it is very difficult to get support from Social Services. It’s all means tested. Support is rationed and it’s very hard to qualify for support” – focus group participant with sight loss. Professionals responding to
“Need to employ more native BSL users to embed the Deaf community within service providers” – Deaf person, focus group “I want to live a happy and healthy life. Old age demands quite a lot of physical health. I want to know the help is out there. I don’t want to go out dancing, I just want to be able
to go out for a walk” – person with sight loss, focus group these findings state that Rehabilitation Officers for Visually Impaired people (ROVI) and Hearing Impairment Social Care Officer support is not means tested but it is based on assessment.
One survey participant demonstrated the potential for co-produced, person-centred, creative solutions: “Would also be wonderful to have classes where elderly mix with children this could be classes/events where can take grandchildren or ones where can interact with children e.g. in schools. Play games, read, crafts…children can be so uplifting for lonely older people. Needs to be accessible by bus and short walk or have adequate parking as a lot of us elderlies do not have a blue badge”. Survey respondents with sensory loss or impairment articulated their desire to meet other people – in particular, people of a similar age, similar interests, or similar impairment.
Services should identify people’s concerns for the future and seek to proactive support where possible. For example, one focus group participant was concerned that communication issues will negatively impact on decisions made about his health as he gets older; that hospitals and medical professionals will ask his family to make decisions for him, without consulting him, and that he will not be in control of his own care or make his own decisions. This is particularly worrying in relation to elder care. Given D/deaf people are born into hearing families there is a real fear of isolation in older years, exacerbated through
cuts to D/deaf focused services.
Communication
All services need improvement to make accessibility easier and more D/deaf friendly. BSL users or D/deaf people need to be embedded within service providers and organisations (e.g., through employment) so that D/deaf people can communicate directly with someone who understands BSL and also the D/deaf experience.
Cardiff and Vale UHB has offered staff training in basic BSL and Deaf Awareness to enable staff to better meet patients’ needs. In 2019/20, 200 staff had been trained (279). Members of the D/deaf communities have provided feedback to the health board that BSL is their first language; and to be aware of the use of jargon (279).
Cardiff and Vale UHB is training staff in medical records to better identify people who may need BSL interpreters for appointments (279). Cardiff and Vale UHB is now the first Welsh Health Board to sign the British Deaf Association’s British Sign Language Charter (279). Staff from both Cardiff
and the Vale of Glamorgan Local Authorities have access to Deaf Awareness and BSL training (29) (30).
What is likely to happen in the future?
The RNIB estimates an increased number of people will be living with sight loss over the next 10 years; from 9,530 to 12,700 in Cardiff (33% increase), and from 4,790 to 6,470 in the Vale of Glamorgan (35% increase) (276). Increases in diagnoses of common sight threatening conditions are all expected to increase; for example, cataract by 36% (Cardiff) and 38% (Vale of Glamorgan); and late stage age-related macular degeneration by 36% (Cardiff) and 41% (Vale of Glamorgan) (276). The prevalence of diabetes is expected to increase by 22% in Cardiff (against a Welsh average increase of 9%, and 6% in the Vale of Glamorgan) between 2021 and 2030; which corresponds to a notable anticipated increase in sight loss due to diabetic retinopathy (17% increase; compared to 5% in Wales, and 1% in the Vale of Glamorgan) (276). An increase in the number of people who have both deafness and sight loss is expected as
older age is the leading cause; and the population of those aged 85+ will grow over the coming years (93). Strokes are a cause of sight loss; the risk of stroke also increases with age (276).
Recommendations
All agencies, in partnership, to:
- Increase awareness of specialist and support services to improve signposting (273);
and improve joined working - Promote awareness and normalisation of BSL
- Anticipate the increase in prevalence of hearing and sight loss in the future
- Increase opportunities for consultation and co-production
- Sign up to the Disability Confident Scheme (200) and develop inclusive recruitment.
The D/deaf community need more D/deaf and BSL users professionals embedded in
services to ensure they are represented and that communication is not a barrier
Cardiff and Vale University Health Board and Cardiff and the Vale of Glamorgan Local
Authorities to: - Undertake Deaf Awareness training for staff to improve the culture for service users, and co-workers who may have hearing loss
- Increase the number of Rehabilitation Officers for Visually Impaired people in line with recommendations (274)
- Design physical activity strategies and plans to increase D/deaf-friendly and D/deaf aware opportunities
Cardiff and Vale University Health Board and Primary Care to: - Improve recording of Deaf people as Deaf in medical records so BSL interpreters can be appropriately booked (273), improving referrals, and experience of health care
- Take additional action to promote equity of access to healthcare services for D/deaf people compared to non-disabled people
- Support the newly established Inclusive Recruitment Team who ensure that they work to the Themes and Goals of the Disability Confident Scheme