Written evidence from Ideas for Ears (AST0029)

Assistive Technologies for people with hearing loss

About us

Ideas for Ears is a social enterprise led by people with hearing loss. We specialise in community engagement & market insight, helping businesses and organisations to interact more effectively with those who have hearing loss by following the principles of co-production. We are based in Scotland but work on projects across the UK.  www.ideasforears.org.uk

Question 1: What role can assistive technology play in removing barriers to work and helping disabled people stay in work?

Research by Ideas for Ears and others has found that most people with hearing loss do not tell their employer that they have hearing difficulties.  Additional research suggests that deaf people face discrimination in the workplace. Human nature does not change quickly so although we may wish people to be more open about their hearing loss, and also wish that others were receptive and non-judgemental of those who have hearing loss, we are not at that point yet.

Great potential. Assistive technology has the potential to make life an awful lot easier for people in the workplace who have hearing loss. It can assist in the following key scenarios, and more:

• one-to-one exchanges at their work station
• conversational exchanges across the office
• informal conversation in social settings (e.g. at the kettle, in the canteen)
• meetings – large and small
• training events
• conferences
• phone calls
• video calls

Options are limited. The range of assistive technology available to support people with hearing loss is currently fairly limited.  Some of the options are impractical or ineffective, others are overly conspicuous or plain ugly. If we want people to adopt assistive technology so they can benefit from it (and so they feel less stigmatized by it) then it is important to get it right with functionality, performance and also design.

Dignity matters.  The simple act of an employer providing assistive technology will not on its own resolve workplace issues for people with hearing loss.  No matter how good something is, the potential user needs to wish to use it.  People do not wish to stand out for wrong reasons, especially in the workplace where you can feel especially vulnerable and exposed if you reveal a weakness.

Learn lessons from the past. We know from the poor uptake of hearing loops that there are barriers in the way of use of assistive technologies. Some of this is about the performance and effectiveness of the assistive technology, but much of it is about user knowledge, confidence and (very importantly) perception and desirability of the product.  See points above.

Early intervention should be the aim.  Assistive technologies have the potential to assist far more people than are currently using them. A big barrier is in the assumptions made by those with hearing loss that their hearing isn’t ‘bad’ enough to warrant exploration or use of assistive technologies. This perpetuates a negative perception of assistive technologies because it associates them with something they quite likely don’t want to have - ‘very poor hearing’. This needs to change because people are struggling far more than they need to.

Audiologists have a role.  A positive mindset towards assistive technologies should be propagated by audiologists.  They are rather guilty of having encouraged a dismissive attitude towards assistive technology because for some time they have promoted a viewpoint that ‘modern hearing aids are so good nothing else is needed’.   There is an opportunity to change things by promoting hearing aids as just one part of the fix.  This is happening here and there but it isn’t standard practice.  The other parts of the fix are: assistive technologies (including new digital apps etc) and, of course, the user’s own behaviours and psychosocial adjustment (these the most crucial aspect of good hearing loss management but can also be the most difficult to achieve).

Knowledge and confidence is key.  The relatively low uptake of assistive technologies is in part a consequence of lack of knowledge by potential users. Information needs to be shared more effectively than it currently is, and this is partly about getting the messages right so the information resonates more with potential users.  For instance, if things are promoted as being for ‘deaf people’, all the many people who don’t feel ‘properly deaf’ (irrespective of whether they medically are) will not engage with those messages.  The other part of the picture is confidence – we need people to be confident about exploring a piece of technology and to feel confident that the solution will indeed be able to help them. The technology therefore has to actually be effective and meaningful (some of the stuff out there misses the mark). 

Co-production is crucial. To get products that are effective and deliver meaningful benefits, we need more co-production at the design/innovation stage, and more user testing and independent product trialling. Ideas for Ears is already pushing itself forward in this area and, for instance, over the last few years has played a key role in the development of new phone technology for people with hearing loss. We have worked to ensure that end users have been as involved as possible in determining how the service will be delivered and in checking its effectiveness. This new service is anticipated to be rolled out to users in the UK later this year. Potentially, it could help people to remain in jobs/roles where they might otherwise have to give them up because of the amount of phone use required.

Assistive technology needs to be set in context.  More and better use of assistive technology should not be introduced in isolation.  It cannot on its own resolve the issues that make workplaces hostile to those with hearing loss.  There is a needs to be time and attention given to the following issues:

• Noise in open plan offices. Assistive technology is not the solution here – it is about staff culture (e.g. chatting noisily with colleagues next to the desk of someone who is trying to concentrate) and the levels of noise generally and how that is mitigated/managed. Research shows noise in offices is an issue for most staff, not just those with hearing loss so there are good opportunities here for employers to get productivity benefits by introducing improvement.
• Acoustics. Echo and reverberation has a huge impact on listening comfort and levels of listening fatigue, especially for hearing aid users. Assistive Technology cannot overcome that on its own, though it can help (e.g. use of a hearing loop in an echo-y meeting room can make listening easier – though only if the microphone is located appropriately and the who system is of a decent specification).
• General etiquette.  Many issues for those with hearing loss can be overcome by people speaking clearly and looking at the individual, and by people speaking loudly enough in meetings and using microphones where appropriate. This should be done as STANDARD not an exception only for the individual who is known to be deaf (especially given that most people who have hearing loss do not disclose that they have difficulties in hearing). This will also make things easier for those for whom English is not their first language and will generally deliver good practice communication standards.
• Communication methods.  As well as introducing assistive technology, workplaces need to think about the way they communicate and back things up with text, where they can. 

Question 2: How should the Government support the development of this technology, and are there any particular innovations it should look to support?

Products worthy of support include:  

1)      Phone solutions that allow people to personalise the sound coming through their handset to match their specific hearing loss. One such solution is also available and another is expected to be available to mobile phone users in the UK later this year. Availability of such services across landlines and internet calls services should follow fairly soon, assuming the mobile phone solution is found to be commercially viable to telecoms companies and investors. 

2)      Smart beacon technology used across the public transport sector to make travelling to / from / for work easier for those with hearing loss. The technology could permit people to receive off-line text messages rather than having to listen to audio announcements. Has scope to assist those with visual impairments and to also be highly desirable for the general public who typically prefer to listen to their own music than listen out for announcements about train delays etc.  Some technology has been trialled but the powerful potential benefits for those with hearing loss have not yet been properly explored. 

3)      Speech to text solutions that automate the transcription of conversation could make a huge difference for making meetings accessible (in the workplace and right across the public sector and in communities).  However, some solutions are better than others and proper user testing is required so efficacy can be measured. Users also need to be properly guided on how to get the best from the technology (e.g. Apps can run on a digital device but mostly a remote microphone is also needed to allow voices to be picked up effectively enough for accurate transcription).  Costs for these apps are variable so people need guidance on what they can get, how good it is, and how they can best use it. NOTE: these digital apps should not be seen as a replacement to communication professionals who provide speech to text transcription.

4)      Phone calls with speech to text transcript. This is technically tricky to achieve and we are just at the beginning of seeing these solutions emerge.  This is potentially really exciting for those whose level of deafness is such that hearing conversation is difficult or not possible. NOTE: this is not the same as NGT or Text Relay because it does not involve a third party listening in and typing up the conversation – it is an app that automatically transcribes. 

5)      Digital assistive listening systems for conference facilities.  These are beginning to appear in some theatres and lecture halls. They are offered as an alternatively to the installation of an induction hearing loop.  They operate via an app on a smart phone or other digital device. It is not clear yet if this system is more or less access and desirable to people with hearing loss. More research is needed into this.

Question 3: Is Access to Work the most effective means of providing access to assistive technology? Should other funding models be considered?

It is effective to some extent but provision of assistive technology is only part of the picture. It needs to be delivered alongside education, not just in deaf awareness, but in the creation of positive hearing and listening environments.  The efforts need to be as much about improving basic standards for everyone so hearing and listening becomes a mainstream agenda item because ultimately it is crucial within the workplace.  A mainstream approach will also ensure that workplaces are suitable for the ageing workforce, a big portion of whom will have hearing loss that isn’t (yet) being addressed by hearing aids.

Access to Work should be connected to the delivery of one-to-one (or small group) support for the individual.  Adjusting to deafness and managing your hearing needs can be very difficult to do, most especially if you quite rapidly move from having good hearing to having poor hearing.  It can take years to learn how to handle certain situations and how to get the best from equipment and devices. It can also take years to adjust and emotionally accept your loss of hearing, even if that loss is mild or moderate.  Outcomes from Access to Work provision could well be much better if they were offered alongside a few sessions with a ‘hearing coach’ and/or lipreading classes.  

January 2018