PhoneAbility

2. Hearing Aids and Telephones - A consumer's view

Vivienne Pozo, Hearing Concern Telecommunications Committee & PhoneAbility

I thought we would begin by looking at the title of the talk - Why "Hearing Aids and Telephones"? Why is this a problem for hard of hearing people?

Consider how often it is necessary to pick up a phone, landline or mobile, to speak to someone. Telephones are an essential part of everyday life and one is at a huge disadvantage if unable to use a phone. Examples of daily use include speaking to someone in the family or a friend; accessing services to order goods or to get an insurance quote; needing a phone to report an emergency; or needing to use the phones at work.

There have been steps in recent years towards addressing the problems, mainly through rights conferred by the Disability Discrimination Act, increased company and government awareness, including the work of Oftel, now Ofcom, but there is still much more that needs to be done. Today's conference will hopefully highlight and address issues facing hard of hearing people, especially hearing aid wearers.

What are the issues to be addressed? Some are listed here:

• Technical issues - need addressing by both the telecoms industries and the hearing aid manufacturers.
• Issues of service provision - services provided down the telephone lines
• Issues of client awareness - is the hard of hearing person being provided with relevant information, particularly at the time of fitting of hearing aids.

We should also consider our consumer group - who are the people we are talking about? The conference is about telecommunications for people who are hard of hearing but not deaf. Individuals, who have residual hearing and can speak, probably wear hearing aids and, most importantly, can use conventional voice telephony.

It is interesting to look at a survey carried out in 1980 (1), which looked at problems faced by and considered major by hard of hearing people. The use of the telephone did not feature then. The main concerns were listening to the radio/TV, difficulty in general and group conversation, hearing the doorbell, speech in noise (the effect of background noise) and hearing the telephone bell.

So, why was use of the telephone not an issue in 1980? We can consider the following:

Audio standards were much better, phones were of better audio quality. I'm not going to go in to detail here, other than to say that this is more because of the better audio standards prevailing at the time, than to any possibility that technology might have been better. We did not have telephone helplines and complex call steering systems to access services. Digital mobile telephones did not exist.

That is the background. I am now going to look at where we are now.

Mobile Telephones:

I will begin with mobile telephony, because this has been addressed recently. Concern about mobile telephony began in the late 1990's when it was realised that the phasing out of analogue mobile telephones would bring problems for hearing aid wearers.

A Hearing Concern seminar in 2000 and a subsequent survey with the Telecommunications Action Group in 2001 highlighted and documented concerns for hard of hearing people, particularly the now well recognised interference problem.

There have been some good developments in the last few years:

• The Mobile Industry Good Practice Guide for Service Delivery to Disabled Customers, in which Vodafone, T-Mobile and Oftel played an important role, was published in 2003.
• We know of phones that cause less interference with hearing aids.
• We know that the hearing aid industry is tackling the interference issue by building better immunity into hearing aids.

However, there is more that needs to be done, particularly in terms of technical aspects and terminal equipment i.e. the telephone handset.

Landline Telephones:

Moving on to landline phones, we have a forgotten story. I have already touched on the historical aspects by making reference to a survey carried out in 1980. Phones were better then, there were no complex telephone based access systems. There was no need to complain, hard of hearing people were on a par with almost everyone else.

In talking about landline issues, I must mention British Telecom. BT has a strong commitment to disabled people, as we now know, going back some 20 years. It recognises the contribution made by disabled people to society and the economy. This recognition resulted in BT coming top in the Employers' Forum on Disability Global Inclusion Benchmark awards for 2003.

I will also mention that the deafness charities - Hearing Concern, NDCS and the RNID are an important source of advice and information for hearing impaired people.

It is worthwhile noting however that most hard of hearing people do not regard themselves as disabled and do not know about the specialist sources of information. They will go, as they have always done, to the ordinary high street outlet for this advice, information and to purchase. Unfortunately all of these aims are difficult to achieve in this way.

There is also the question of good quality phones in public places, for public use. We might be looking at hotel rooms, hospitals, places of employment, transport centres and so on.

And then there is the role of the healthcare professional, who should ensure that his or her client has knowledge about and access to all sources of information concerning telecoms.

I thought we might consider what makes a good phone for a hard of hearing person. To do this it is necessary to look at the way in which the degrees of hearing loss affect the ability of a person to use the phone:

• A person with a mild hearing loss might not wear hearing aids and may do with an ordinary amplified phone. Or simply a good phone with a good quality audio output.
• A person with a moderate loss (and probably wearing hearing aids) may need amplification and/or inductive coupling.
• A person with a severe loss will use amplification and inductive coupling. Since lengthy conversation can be difficult to follow he/she may rely on text (e-mail, fax, textphone) as back up.

There is of course a proviso when talking about telephone coupling, which is that the hearing aid must be equipped with an inductive coupler, more commonly called a telecoil. The client should know about it, and the benefits it can confer.

Our evidence suggests that while most behind-the-ear hearing aids have inductive couplers, and that will include the NHS range of digital hearing aids, the client is not made fully aware of all the benefits inductive coupling can bring. This is an area that audiologists and those involved with hearing aid dispensing and follow-up services could perhaps address better.

We will now consider three examples of everyday usage of the telephone, which can create difficulties for hard of hearing people. I will take situations relating to landline phones, but it is worthwhile noting that every one of these scenarios is applicable to the mobile networks, and that at present access through these networks is not guaranteed because of the interference problem. Currently landline phones employ analogue technology but digital technology is used in the form of cordless DECT phones. We should also note the need for inclusive design - to take account of other disabilities - those of sight, mental or motor function; and to remember also that disability is not always something one is born with - transient or permanent disability can be acquired at any time as a result of illness or accident. Ageing is often associated with one or more disabling processes.

Emergency situations:

An essential requirement of the telephone is the ability to contact the emergency services. For a hard of hearing person, especially if alone and the only person able to report, the situation can be fraught with anxiety.

I have listed hotels here as an example of such a situation, but there will always be others, nearly always associated with being alone and on the move. This will include people who travel in the course of their work - at the other end of the spectrum it will include retired people, who now form a big market for the tourist industry.

The situation may not affect the personal well-being of the disabled person - it could well be that someone else, for example, a partner or a child, needs help, in what could be a life threatening situation. This perhaps illustrates an important role a hard of hearing person may have to play.

In all emergency situations one needs to be able to use the nearest phone, often without delay.

In most cases, there will be other people around, people who can help. That said, a hard of hearing person does not want to rely on other people for help - he/she needs to be able to act just as anyone else would - independently, in control and in any situation.

Employment:

This is a very timely opportunity to remind ourselves that not all hard of hearing people are older or retired. Some are of employable age, often throughout their entire working lives. They want to be able to pick up and use any phone in the work place. The increasing usage of cordless phones, incorporating digital technology, in the workplace poses a new problem for hearing aid wearers.

There is reluctance in the UK to label phones showing their suitability for disabled people - it is not possible to look at a phone and know if it is usable by a hearing aid wearer. There is no visible guarantee of its effectiveness.

I recently assisted a hospital in its DDA audit. At one point I observed a hospital manager pick up a phone to look for some visible marking showing its suitability for hearing impaired people. Needless to say there was none.

Finally, a note of how a little proactive thinking, by the employer in this instance, could remove barriers to employment - by providing good phones throughout the work place, i.e. accepting nothing less than good. Then perhaps the issue of ability to use the phone in the workplace might never even arise for the hard of hearing person. There are employers who already use suitable phones, but they appear to be the exception, rather than the rule.

Call Centres:

I am now going to talk about call centres, specifically the point at which one speaks to the adviser. Here a call is usually being made because there is a problem, and if it proceeds with difficulty it can be hugely stressful. It is a different perspective, because here one is talking about the person the other end of the line.

The point I want to make is that the quality of the phone on the sending end can affect the ability of the caller to hear and understand. This is of course applicable to any call that one makes but I am using the call centre as an example, because of their prevalence in our everyday lives.

Typically problems include lack of clarity of the adviser's voice and the background "babble" - the noise created by all the other advisers in the centre.

Sometimes I have had to give up on calls to call centres, because it has been so hard to follow. But I can remember one call where the adviser's voice was clear and I could almost hear the silence - there was no background noise. Which shows it can be done.

There is no doubt that deaf awareness training is making its impact, I myself can see the change in the way advisers speak on the phone. But what is the point if you do not give them good equipment to use?

Conclusion

In conclusion, why did this conference happen? The idea was mooted, almost two years ago, from an increasing concern that hearing aid wearers were being overlooked, by both industry and government policy makers, in the context of telecommunications.

Digital mobile phone issues were already being addressed and there is ongoing work there. Landline phones and services now need addressing, in very much the same way as for mobile services.

Consider what is happening elsewhere:

The United States:

There are already mandatory requirements in the US for hearing aid compatible telephones in workplaces and places of public accommodation. By definition, a hearing aid compatible telephone is one equipped with internal means of use with hearing aids equipped with a telecoil.

A Federal Communications Commission ruling made last year requires that 25% of digital mobile phones be made hearing aid compatible in two years, and 50% in five, prior to the running down of the US analogue service network. This can only mean good news for the UK consumer.

Europe:

In its final report to the European Commission, INCOM, the committee set up to look at inclusive communications for disabled people, makes little reference to hearing aid wearers. There is good reference to the problems of digital interference with hearing aids, but little reference to landline telecoms issues.

And finally, the UK - what can we do here? A few suggestions:

• Continue to address service provision and equipment issues in a proactive way. Examples of this include the Mobile Industry Good Practice Guide, which I've mentioned, work on call steering systems and access to the emergency services for deaf and hard of hearing people. The disability organisations can continue to work with the government and industry to achieve these aims.
• Consider the provision of information to hearing impaired people - I've already mentioned the role of healthcare professionals, for example, audiologists, hearing aid dispensers, and hearing therapists, in this context.
• Address technical issues to ensure that hearing aids and telephones work well together. A hearing loss need not cause problems when communicating with the wider environment, by telephone.

(1) Barcham and Stephens (1980), in Ballantyne's Deafness, Sixth Edition 2001, p6. Edited by John Graham and Mike Martin.

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