BSL Health Navigator project - improving outcomes, access and waits for deaf British Sign Language users

What is the BSL Health Navigator Project addressing?

9 million people in the UK are Deaf or hard of hearing, and BSL is the preferred language of over 87,000 Deaf people, for whom English may be a 2nd or 3rd language.

Studies show that the Deaf community has a higher-than-average prevalence of health conditions which do not derive from deafness, most of which are preventable, leading to health inequalities and increased mortality.

Despite existing policies, legislation and systems, health services consistently ‘fail’ the Deaf Community. Miscommunication, inaccessible information and lack of understanding lead to delays in healthcare appointments and treatment.

Since April 2022, we have been working with Deaflink, Newcastle Hospitals and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust to deliver an innovative BSL 'Health Navigator' role to improve healthcare outcomes, access and waiting times for Deaf people.

In May 2023 we were awarded a Health Foundation award to support this work.

What do the BSL Health Navigators do?

BSL Health navigators are Deaf people who are native BSL users. They ensure that the patient is fully informed and empowered at all stages of the patient pathway, from access to discharge. They:

• Support the flow of communication and information between health teams and the patient to ensure there are no delays or unwarranted waits for treatment
• Prepare patients for healthcare appointments, ensuring they get the most out of their appointment and supporting staff to offer an equitable service
• Support discharge and improve flow, releasing resources for other waiting patients
• Engage with the Deaf community to better understand barriers to access and innovate ideas which reduce health inequalities

How is the project delivered?

The project is managed by Deaflink and is overseen by a multi-agency steering group made up of people with lived experience of Deafness and links with the Deaf community, and the three NHS Trusts, which provide acute, community and mental health services. We also provide QI expertise and project support.

We meet every month as a steering group; this forum allows us to identify barriers that prevent access to services and work more effectively together to raise awareness and generate solutions to complex issues such as access to reliable BSL interpretation services. Working in this way has helped us integrate our organisational approaches, share key information and resources. This organisational co-ordination means that there is greater consistency of approach across our geographical footprint which we hope will improve patient experience and outcomes.

What have we achieved?

We have two Health Navigators in post, who are based in Deaflink, and work to improve access to healthcare for Deaf people across all the partner organisations and other healthcare services such as primary care, social care, dentistry, pharmacy, counselling, patient transport, care homes etc. The Health Navigators are Deaf people who deeply understand the issues faced by Deaf people and who are experienced in helping improve access to health care through their knowledge of healthcare systems and processes.

Since we started in April 2022, over 80 BSL users have accessed the Health Navigators, often using the service multiple times after they have discovered how useful it is. The Navigators have offered 2,885 healthcare related contacts, often needing to provide help at multiple points to ensure the success of a single healthcare appointment. For instance, the Health Navigator may communicate with the client; their GP; a hospital consultant and hospital administration for a single appointment, plus help with any follow up actions. Over 70 different types of health conditions have been supported, suggesting co-morbidity and successive health episodes. The Navigators have helped to highlight just how complex it is for BSL users to access healthcare and how many barriers there are to overcome.

The project has helped Deaf people to have better access to a wide range of acute emergency and ambulatory care, outpatient appointments, mental health treatments, social work, dental care, pharmacy, and primary care. The most frequent type of support from the Health Navigators is to help BSL users:

• Feel better informed about their healthcare appointment and the processes that surround it
• Contact healthcare providers on their behalf
• Ensure interpreters are in place
• Access appropriate healthcare advice
• Feel better emotional support and empathy

The Navigators also support the education and awareness of health professionals about BSL users’ needs and rights. Crucial elements of patients’ journeys have been improved through:

• Improvements to their healthcare pathway and health outcomes
• Supporting informed consent
• Increased staff understanding of Deaf patients
• Improving access and reliability of interpretation services

What have we learned?

Trying to improve healthcare access for BSL users is hugely complex. We are achieving more by taking a partnership approach than we would have done by trying to address this issue as separate organisations.

We have been very lucky to work with Deaflink. Without the charity’s ability to host, supervise and organise the Health Navigator service, we would have been much less effective. Deaflink has many years of experience of building trust and relationships with the local Deaf community and so was able to promote the service and help signpost it to BSL users that were facing challenges in accessing healthcare. Having Health Navigators that have lived experience of Deafness, but who are also expert in health system navigation and the use of BSL interpreters has been crucial to our success to date and we are very grateful to the Deaflink team for their passion, dedication, and expertise.

As part of this work, we commissioned an independent evaluation which reported its findings in May 2024. The evaluation highlighted that the project reduced complaints, increased BSL interpreting fulfilment, and increased uptake of interpreting services, and that these results alone had covered the costs of running the programme.

We are delighted that this project has been shortlisted as a finalist for the 2024 Patient Experience Network National Awards, which recognise best practice in patient experience across health and social care in the UK. Results will be announced on Thursday, 3 October.

To find a copy of the BSL Health Navigators leaflet, please click here.