§ Order for Second Reading read.
§ 2.30 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
I beg to move, That the Bill be now read a Second time.
In moving the Second Reading of the Bill, I am conscious of a privilege. The House has been well served over the years by right hon. and hon. Members who themselves have suffered a disability and yet succeeded in serving this House well. In trying to put forward a Bill which I believe will help deaf people considerably, I follow the tradition set by the late Edward Evans, who used to be the hon. Member for Lowestoft and who for many years was recognised as the spokesman for the deaf in this House. Since he left the House in 1959, no voice has been identified with the disability of deafness and therefore it is a privilege for me to be able to follow in the footsteps of my late colleague.
This is a difficult Bill because it does not fall easily into compartments or categories. It has a number of provisions. It seeks to ensure that the prescription, fitting and servicing of a prosthetic appliance—a hearing aid—is only done by professionally qualified people. This is the only prosthetic device to aid a disability which is not fully regulated or governed in some form or another.
Despite the fact that there may seem to be a parallel with the case of spectacles for those whose eyesight is failing, there is in fact no genuine parallel because the fitting of a hearing aid which is not the right appliance for a person's disability cannot impair the hearing mechanism of that person, whereas a pair of spectacles, such as could be bought from Woolworths at one time, could definitely impair the eyesight of the wearer.
So, on strict health grounds, I cannot put up a case that it is right that there should be professional standards of fitting and making appliances for people wearing commercial hearing aids because, unless there are professional standards, the mechanism of the ear will be impaired. In the same way, it is difficult to say, however, that a paraplegic cannot get about in some way or another in spite of his disability and that no further deterioration will occur if we do not provide him with an invalid carriage.
916 What I am seeking is to give protection to the person who goes to a hearing aid manufacturer or supplier so that he is able to be assured that the appliance he buys will assist in his problem and will not add to the difficulties that can arise for a person trying to cope with a disability in the community at large and. in addition, lead to his being harassed and in a state of nervous anxiety because he is trying to cope inadequately through bad professional service.
I have had a shoal of letters since the House gave me leave to introduce the Bill. I quoted on the previous occasion a case in my constituency and I want to emphasise the importance of this to people who are hard of hearing. About 2¼ million people in this country are affected by hearing disability, of whom about 800,000 or perhaps 1 million are already catered for by the Medresco aid issued by the National Health Service. I have a letter here from a Harley Street specialist an otolaryngologist. He said:As a doctor over forty years, I hear and have heard plenty of complaints of those high pressure salesmen who get £60–£100 from poor old people with startling promises of what they can expect and in the end no real result. It is to my mind the biggest racket of all".I have another letter from a Kent doctor. It is a long letter detailing the case of one of his patients. He saysA patient of mine, a spinster in her 70s and severely crippled with arthritis, so that it is all she can do to get the 300 yards to church …bought an aid. When she complained that it did not help, the salesman "bullied" her and said that it was much too soon for her to give up. After more pleading, the firm eventually said that it did not suit her but that a second aid was just the job. It then admitted a further mistake and said that what she really needed was Model No. 3. The doctor adds:You may be interested to learn that she was now £120 out of pocket. … This has taken most of her life's savings.My colleagues on the Front Bench can duplicate that story time and again—stories of people who have been trying to cope with their deafness or who have been in the situation where relatives have got tired of shouting and have said, "Grandfather is not really deaf. He 917 can hear when he wants to," and persuaded him to try an aid. My problem here is that the disability of deafness gets the least sympathy from the public of all disabilities and part of the objective of this Bill is to give deaf people the kind of sympathy that other disabilities attract, and at least that they can have a fair deal.
As I have said, everyone will accept the need to try to do something and the Bill falls into two distinct categories. The first half is that which requires professional standards. One cannot sell a prosthetic device in the same way as one can sell a vacuum cleaner. The Board of Trade can test a cleaner and judge its advertisements and so on. But when a person is deaf he does not lose the whole range of hearing and can amplify all sounds. It will be easy for you, Mr. Speaker, to imagine a keyboard which has lost five notes in one place and five in another. It is the same with a deaf person. He has lost notes here and there. If, therefore, a hearing aid amplifies all sounds the result is confusion worse confounded.
Therefore, if we are to protect the person who buys a hearing aid, that aid must suit the particular disability and must be prescribed and fitted in the same way as any other prosthetic device may be fitted to a disabled person. It is because these devices do not fall easily within the category of Board of Trade protection for consumers that the Ministry of Health comes into the picture.
I have said that there is no immediate damage to the mechanism of the ear and, therefore, inevitably a large proportion of the Bill must be reckoned to be consumer protection. I want to deal with some of the aspects that will arise if the Bill becomes law and which might be used as objections to the Bill going forward in its present form. Incidentally, I accept that no Private Member's Bill is ever perfect in form and I should be delighted to receive further help in getting it nearer to perfection. I seek the statutory registration of people who deal in these aids. This would not be a professional body directing and governing itself. My proposal is much wider.
The Bill would provide that the council would consist of 42 per cent. coming from people who actually manufacture, 918 supply, retail or import hearing aids and, for want of a generic terms, in the Bill I have called them traders. But 58 per cent, of the council would be die consumers, the audiologists, the doctors and consultants and representatives of interests like the Royal National Institute for the Deaf and the British Hard of Hearing Association. The council would not be comparable with the kind of organisation which the Monopolies Commission is examining, such as that of lawyers who have a professional association which has certain practices, or such as that of the dentists. If the dentists had an organisation such as I am suggesting, the majority of those on its council would be representative of the people who have their teeth pulled or filled or stopped. My council would not fall into that kind of professional category, therefore.
I appreciate that there is always a problem when one has an organisation which does not fit neatly into a compartment, and it might be said that my council would create a precedent and that councils would be popping up all over the place wanting to regulate this, that or the other. But I contend that this is the only prosthetic device not covered, and the only other possibility which I can foresee of a similar council would be if, as the result of a great deal of research which is now marching forward, there were electronically controlled artificial legs, rather as there are electronically controlled artificial arms. If that became a commercial proposition, there might be such a council to make sure that the fitting was done correctly. But there are no other grounds for saying that my proposed council would establish a precedent.
There is then the question of whether there are other means by which the object of the Bill could be met. Unfortunately, I do not think that that is possible. For example, it would be very helpful if hire purchase were much more effectively on the side of the consumer and if there were things like a complete stand-off period between signing and sale. But that cannot apply to a hearing aid, because the time factor involved could not possibly apply to any other commodity. I remind hon. Members that it takes at least a month, and it took me three months, to know whether a hearing 919 aid is of any value in one's disability. I cannot see how there could be provided such a tremendous stand-off period for any other commodity. The same is true of doorstep selling. A certain amount of protection can be given, but when a person is using a hearing aid to counteract his disability, a rehabilitation process is required which may take months and months.
If the process is done ethically, then the right thing to do is to go into the deaf person's home and to conduct the test there, not in a sound proof room where one may hear the clock ticking, but not hear anything else. Hon. Members would be surprised by what a Commonwealth Parliamentary Association reception sounds like to someone wearing a hearing aid and trying to sort out the conversation of someone from Botswana, and someone from Jamaica. But that is the kind of condition in which a deaf person has to use the apparatus, not a sound proof room. For a number of reasons, servicing is as important as the right prescription and fitting.
In preparing the Bill, I have taken as my model the Opticians Act, 1958. What I am trying to do about hearing aids is largely identical with what was done about spectacles by that Act, and in some of the Bill's provisions about discipline and so on I have leaned very heavily on that Act. I have also leaned heavily on the Professions Supplementary to Medicine Act. It is amazing that I cannot have my corns cut without the chiropodist being registered and having to maintain a professional standard, but that my hearing, which is far more important to me than my feet, can be messed about by any Tom, Dick or Harry who cares to poke something in my ear. There are problems in other respects which are met by people requiring professional services which my Bill would help to solve.
I am in the fortunate position of having achieved a large measure of support from the country at large. I also pay tribute to my colleagues on the opposite side of the House. The hon. Member for Ross and Cromarty (Mr. Alasdair Mackenzie), who is one of the Bill's sponsors, has been a constant help to me in the early stages of the Bill and he carries with him the support of his party. A previous 920 Minister of Health, the right hon. Member for Thirsk and Malton (Mr. Turton), who introduced the Opticians Act, the hon. Member for Plymouth, Devonport (Dame Joan Vickers), the hon. Member for Hertford (Lord Balniel) and other sponsors from the Conservative benches and the Parliamentary Labour Party Health Committee have given me full support.
What has been most amazing has been the support of those whom the Bill seeks to control. I make it clear again, as I did when seeking leave to bring the Bill before the House, that there are many traders and retailers who are completely ethical and who give tremendous service to sufferers who cannot be satisfied in their particular disability by the Medresco aid. The majority of these traders are ethically sound, and the Bill does not seek to do anything which would hinder them in the continuation of their work.
The organised traders are at present within two bodies. One is the Hearing Aid Manufacturers and Suppliers Association, which includes firms like Multitone, Amplivox, Ardente, and Fortiphone and other well-known names. I have a letter from the chairman of that organisation, Mr. B. Montagu, saying:May I wish you every success on March 3rdand this was after long correspondence in which he gave me his constant support. I pay tribute to Mr. Montagu for the way in which he has supported the Bill, both in the interests of the trade and of the deaf people concerned.
The other organisation is the Society of Hearing Aid Audiologists which consists of people who, similarly to opticians, have hearing aid centres—"shops"—and who are qualified to fit. I have had a letter from the Society wishing me good luck in bringing the Bill before Parliament. The Royal Institute for the Deaf has given me considerable support, as have the British Hard of Hearing Association, the British Association of Otolaryngologists of the Royal College of Surgeons. The Consumer Council has given complete support to the Bill and attended to much of the drafting.
It may interest the House to know how the Bill started its progress, at least how I got the idea for it. On 3rd April, 1964, 921 there was an article in the New Statesman on exploiting the deaf, an article which I read with great interest. It quoted some of the things which had happened and showed where the consumer needed protection, and it concluded by saying:The promotion and sale of hearing appliances certainly call for investigation by the Consumer Council … it might still be necessary to introduce legislation …The author of that article was then the chairman of a committee of which I was then vice-chairman, the Parliamentary Labour Party Health Committee. He is now the Minister of Health. I am following his good advice. The Consumer Council's investigation for which he then asked produced a report entitled "Deaf Aids", which is the wrong name, because they are hearing aids. From that emerged the solid feeling that legislation would be necessary if we were to control and to give some kind of protection to the people using commercial aids.
The Medresco aid is quite free and is professionally fitted. It is a first-class instrument for 75 per cent. of cases and no one within that percentage needs to buy any other instrument. But its design is 10 years old. In addition, there are some people for whom it cannot give the service that a commercial aid will give. I am one of them. The House will have seen that I am wearing two aids. They would cost £150. I would be delighted if my hon. Friend the Parliamentary Secretary could tell me that this sort of aid would shortly be available on the N.H.S., free to all users.
In the realities of the situation the most that I can hope for in the fairly near future is that the present body-worn aid will achieve a greater degree of selectivity in order to give help and relief, especially to professional people who may need it in the courts of law or even in places like the House of Commons. In the meantime, people will inevitably turn elsewhere. We look for a miracle, and all the time what we really want is a new pair of ears. If anyone would give us a new pair of ears we would give them the moon. There is this tremendous feeling: "If only I could hear."
I told the House that one of my delights is good music, symphony and opera. I face the fact that without an aid the whole of that world of art would be dead 922 to me. With the Medresco aid, such music in the Royal Festival Hall is equally dead to me. There will be people who have a strong urge to solve their problems, and the industry is doing its best to help. These traders need protection from the fly-by-nights. This Bill is attempting to establish a kind of standard, and control the people in an industry who do not compete on fair terms.
The production cost of the aids that I am wearing would be about £12. In other words, there is a margin of £60 between the cost of producing the instrument and its selling price. That margin can be justified if one is spending a lot of time on servicing, rehabilitation, training and ensuring that the aid works correctly. If someone sells an aid for £60 or £70 and then one cannot get the necessary adjustment, this is highway robbery, and it is where protection is needed. The fitting of the mould into an ear is a highly skilled job. If the mould does not fit correctly then the distortion is worse than when the person is not wearing a hearing aid. Inevitably, because I am a Member of Parliament, I may well receive even greater attention than even an ethical firm would give anyone else.
But I can tell the House that the mould on my right ear is the fifth that I have had before obtaining a satisfactory fit. If this happened to an elderly person, he would inevitably reach the stage where he gives up. A firm can therefore get away with bad service, but it is unnecessary for that to be so if the regulations governing the fitting, prescribing and servicing of aids are fully accepted as a statutory undertaking. There has been much discussion about whether it would be a costly undertaking to establish another council. I have drawn heavily upon the General Optical Council for my information and if the House saw fit to give the Bill a Second Reading and pass the necessary Money Resolution, at the most the Measure might cost £5,000 a year.
I realise that this sum has to be added to all the others, but if we cannot find £5,000 out of a hard-pressed economy, who for people who are hard of hearing I find it difficult to understand how we can find £10,000 for a pub in Wales, in order to help Messrs. Whitbread provide a service to a community, or how 923 my hon. Friend the Minister of Education can find so much money to give to golf courses. I do not want the House to misunderstand me. I have no objection to either drinking or playing golf, but £5,000 would be a well-spent sum on behalf of that part of the community which is so disabled.
The Bill would provide for a register and for registration. This would mean that there would have to be a registrar and an office. The registration fee is not to be compared with that received by the General Optical Council. In that case there are something like 11,000 people able to pay an intial fee and an annual renewal. This Bill would apply to something like a dozen large manufacturers and firms, and about 700 professional hearing aid audiologists, incorporated perhaps into some 200 or 300 firms. The amount forthcoming in fees from the hearing aid industry would be about £2,000 to £2,500.
The Bill seeks to establish a code of practice, which will deal with the construction, durability and amount of permitted distortion. It is drawn very widely and it is similar to that already operated by the ethical manufacturers and suppliers. The difficulty is that at present, without this Bill, it is impossible for them to enforce the code upon the naughty boys, because of the way in which hearing aids have to be sold. Hard selling to the hard of hearing is a common practice.
Inevitably the salesman is working on a large commission basis. Because of the competitive nature of the business, unless a code of practice can be enforced it is not worth the paper that it is written on. A kind of Gresham's law operates whereby the fly-by-night salesman forces the standard downwards of those who would like to be more ethical in their approach.
Standards of training need to be promoted. Clause 5 would institute training and would seek to have examination and standards approved. One of the valuable by-products of the Bill is that it seeks to incorporate in it the Society of Audiology Technicians, which concerns itself with those who are working on Medrescos in hospitals in the National Health Service. The standards of prescribing, fitting and servicing need to be raised throughout 924 the community. We should have in the Health Service audiologists comparable to those working outside. Standards should be raised and proper professional standards would be a means of enriching both within and outside National Health Service provisions.
One of the difficulties of the Minister of Health concerning all the ancillary services of the National Health Service is that the rates of pay are not comparable to those which a similar skill commands in trade or industry outside. One of the byproducts of the Bill in establishing proper training standards would be that it would not only benefit the people who are in the commercial hearing aid industry but it would help to raise standards in the National Health Service.
The Council would have power to vet advertisements. This is very important, and it is something which an ordinary voluntary system cannot possibly cope with. It is not just a question of whether an advertisement is true. It is a question also of whether it is applicable to the disability concerned. We have all seen advertisements which pretend, first, that the problem is very small and that one is merely out of focus and need not worry very much, and, secondly, that the aid is entirely invisible and nobody would notice it. I look forward to the day when nobody minds whether it is invisible and when people accept that wearing a hearing aid is like wearing a pair of glasses to overcome a disability.
There is at present no mechanism for receiving the kind of complaints of which I have a complete file here. I have received over 100 letters since the House gave me permission to bring in the Bill on 1st November. The council would have the right to receive and investigate complaints.
One of the difficulties of the wearer of a hearing aid is that he is never sure whether the poor performance which he is getting from his aid is attributable to the aid or to himself. There is no exact measurement. One cannot test it in any way. The fact is that if one has catarrh in the morning one's aid does not work as well as if one does not have it. If the House decided to meet at 10 a.m. and to go home at 2 a.m., I should lose five decibels of sound between 10 p.m. and 2 a.m. the next morning. Because there is no way in which a person can be 925 certain whether the fault lies with him or with the aid, there must be professional backing. One must be able to complain and to be able to have one's aid tested to know whether the distortion is lower than should be permitted to give the hearing which the person is entitled to get.
As in the General Optical Council and in the Professions Supplementary to Medicine Act, there is provision in the Bill for a disciplinary committee which will have the opportunity to act, having examined the difficulties which may have arisen over advertisements, over complaints of unprofessional conduct or practice, or over anything on which there is no stop in the present code of practice but which causes great annoyance. A person who optimistically fills in a coupon in a newspaper may have as many as six or seven calls in spite of the fact. that often an assurance has been given to the contrary. Under the code of practice proposed, these kinds of badgering calls should not be made. The ethical firms do not indulge in them. Matters of this kind could be referred to the disciplinary committee.
A further difficulty which arises is that there are two distinct specialties involved. The otologists are concerned as surgeons with the hearing mechanism, and the audiologists are concerned with the electronics and the way in which sound vibrates and the way in which an instrument can interpret that sound. I have sought in the Bill to bring both specialties into one consultative body. At present it is very difficult in the Ministry of Health to marry the otologist and the audiologist, the neurologist and geriatrician, and not least the psychologist into the kind of body which can help the person whose hearing is impaired. All those specialties are concerned with it. The Bill seeks to make sure that the way in which a person tries to cope with his disability calls in aid as much as possible the wide spectrum of advice that is avail- able before a hearing aid is either prescribed or fitted and to ensure that it is adequately serviced.
Naturally, I have had to include an Interpretation Clause, by which "hearing aid" meansa prosthetic device for the amplification of sound to assist persons with impaired hearing".926 The basic element of a hearing aid is mainly that it is a means of amplifying sound. I did not wish to bring within the Bill the sale or servicing of transistor radios. Therefore, one has to be clear that it covers only prosthetic devices.
By the Interpretation Clause "salesman" meansa hearing aid audiologist, a person competent not only to sell but also to fit a hearing aid and advise on its use"."Audiological technician" meansa person competent to repair and adjust the mechanism of a hearing aid".The description "trader" covers the whole scope of firms, corporate bodies, manufacturers, importers and anybody who has to do with the preparation of a hearing aid and getting it into the ear of a person with impaired hearing.
There are two Schedules to the Bill. The first specifies the constitution and powers of the Hearing Aids Council. I had to face the possibility of having a large council which would have to work through sub-committees or a small council which could act on its own. if the Bill were passed in its present form, four persons would be nominated by the Privy council, two by the Royal National Institute for the Deaf, one from the British Association of the Hard of Hearing, one from the British Association of Otolaryngologists, one from the Institute of Laryngology and Otology, one from the Society of Audiology. Technicians. four from the manufacturers, four from the Society of Hearing Aid Audiologists and one from the Consumer Council, giving a body of 19 persons which, I believe, would adequately fulfil the functions which the Bill sets out to perform.
There are a number of details similar to those concerning the General Optical Council, with which the House will be familiar. The disciplinary committee will cover the same kind of ground that the disciplinary committee of the General Optical Council covers. The difference between the two bodies is that whereas in the case of the Hearing Aids Council the Bill provides for a permanent ratio of 42 per cent. representing trade interests and 58 per cent. from doctors and the welfare associations, it is obvious that in the disciplinary committee it is only fair to have an equal number of traders and non-traders because it is the traders who will be disciplined. 927 That body would be under the chairmanship of the president of the council, who would be appointed by the Privy Council.
In the six months which have elapsed since the House was kind enough to give me leave to introduce the Bill, I have sought to iron out as many of the possible objections as I could. I have had long meetings with the interests concerned and once again I pay tribute to them for the way in which they have sought to be constructive. I have had considerable advice from consultants and hearing specialists and considerable help from the welfare officers of local authorities concerned with deafness and from organisations like the Northern Regional Association for the Deaf and the Southern Regional Association for the Deaf. I am now in the situation where I have to throw myself on the mercy of the Government in the hope that this Measure, the purposes of which are, I think, generally acceptable as being good and desirable, will not be found to be impossible to fulfil for technical reasons.
On an earlier Bill, today, we discussed the problem of loneliness of elderly people. The loneliness of a deaf person, whether he is old or young, is something which only those who have suffered it can realise in terms of human suffering. For a person who is an extrovert type, who loves his fellowmen, is gregarious and wants to mix with them, to be found that he is cut off from that friendship may seem to be a small matter, but when this House is not concerned with this kind of thing affecting a small section of the community suffering from a disability, this House will no longer be serving the kind of function which my constituents sent me here to serve.
§ 3.10 p.m.
§ Mr. Alasdair Mackenzie (Ross and Cromarty)
I support with great pleasure the hon. Member for Willesden, West (Mr. Pavitt) on this Bill. I was aware for a long time that many people suffered from this disability and they certainly have my sympathy, but I am more convinced than ever after hearing the hon. Member, who speaks from experience, proposing the Second Reading of his Bill, in such moving terms and explaining its various provisions. I congratulate him on the 928 very clear and explicit manner in which he stated the case for the Bill.
I think we must all agree that those of us who know something of this problem from our experience as local authority members and as Members of Parliament realise the necessity for introducing some legislation to ensure that necessary standards are maintained and that those who sell these aids and also audiological technicians are qualified for their work. At the moment it seems that a great many people are selling hearing aids without having the required standards.
Very considerable improvements are made from time to time. It is important that those who suffer from this disability should know about the latest developments in this matter. This is important because hearing aids are very costly. Those who suffer from this disability and are carrying on in important jobs have frequently to change their instruments. They find this a very costly matter. There is a case for the Chancellor of the Exchequer to make a concession in respect of these instruments.
On 31st January last I tabled a Question to the Chancellor asking if the purchase of a hearing aid by a person who needed it for the purpose of continuing in his profession or work wasregarded as a legitimate expense against which Income Tax rebate could be claimed".The Answer was thatan employee is not entitled to tax relief for an expense which arises from his personal circumstances.—[OFFICIAL REPORT, 31st January, 1967; Vol. 740, c. 35.]I was very disappointed with that reply, because people who have to buy tools and instruments for their work in various trades and professions get such a concession. It is very disappointing to find that a person who needs a hearing aid to carry on his or her profession should not be able to get some concession in this respect. If this is the law, it is time it was changed. I know of many people who suffer hardship because of this.
The hon. Member for Willesden, West, said that he looked forward to the time when a hearing aid was regarded in the same light as spectacles. This is how hearing aids should be regarded. A hearing aid is as necessary for a person who suffers from defective hearing as a pair of spectacles is for someone who has poor eyesight. 929 The hon. Member put the case very carefully. I hope that the Government will look with favour on the Bill. It is a good and necessary Bill. The Government may not like some parts about it as drafted, but there will be time to make Amendments in Committee. From the Liberal Bench I give my fullest support to the Bill. I hope it will be accorded an unopposed Second Reading.
§ 3.16 p.m.
§ Mr. George Wallace (Norwich, North)
In general I support the Bill. Its intention is good. Its general principles cannot be objected to. However, it would be far better if people suffering from this great disability took the most sensible course of seeking medical advice and following it, preferably through the National Health Service. The wisest course is to be treated by a qualified practitioner.
I agree with the hon. Member for Ross and Cromarty (Mr. Alasdair Mackenzie) that hearing aids should be regarded in exactly the same light as spectacles. I do not think that spectacles are advertised. I can remember the time when one could go into the big popular stores and see great trays of spectacles on sale. People, in the main elderly people, could be seen trying them on and buying them cheaply. No doubt in the process they ruined their eyesight, but they obtained something at a reasonable price. This was before the National Health Service.
Today there is the same approach in regard to hearing aids. There is a tendency for people to see a well presented advertisement, for them to build up hope, to spend a great deal of money, and to be bitterly disappointed.
I know that my hon. Friend the Member for Willesden, West (Mr. Pavitt) has devoted a great deal of time to this matter. Clause 6 allows advertising. I do not think that advertising should be allowed to continue on its present scale. I would go as far as to stop advertising, in an attempt to stop the present high-pressure salemanship. I object to high-pressure salesmanship seeking to profit from disability. We should take a dim view of high-pressure salesmanship of false legs. Deafness is a great disability and an embarrassing one.
930 If the Bill reaches the Committee stage, very careful consideration should be given to the question whether advertising should be allowed. I have advocated that people should use the National Health Service. The Minister and his Department should consider making the aid supplied through the National Health Service more attractive and less obvious. Through the wonderful developments which have taken place, hearing aids can be installed in spectacle frames so that they are not conspicuous. A hearing aid is not like a pair of spectacles. Spectacles improve the appearance of some people, though I make no personal claim in this regard, but a hearing aid can be conspicuous even if it is small. Out of respect for people's sensitivity we should seek through the Health Service the provision of a hearing aid which is less conspicuous, because many deaf people are often easily embarrassed because of their handicap.
Public attention should be called to the great danger of dealing with advertisers of deaf appliances in newspapers and magazines without getting proper medical advice. I am not stretching the imagination too far when I say that a hearing aid imperfectly fitted could lead to loss of life, particularly in a street accident. It is as serious as that.
I pay tribute to my hon. Friend the Member for Willesden, West for introducing this Bill. I have been in this House for quite a while now and I am aware of the tremendous amount of work that he does outside this House in connection with this subject. Credit should be given where it is due. If the Bill should not be given a Second Reading—I do not know what will happen, because one cannot forecast a decision of the House—something on the lines of this Bill should be done by means of a Government Measure.
§ 3.22 p.m.
§ Mr. W. O. J. Robinson (Walthamstow, East)
I join in extending my congratulations to my hon. Friend the Member for Willesden, West (Mr. Pavitt) on having brought forward a Bill of such considerable importance to perhaps a minimal number of people but, nevertheless, to an important class of people. My congratulations relate not only to bringing in the Bill but to the extremely able and interesting way in which my 931 hon. Friend outlined the problem which the Bill is designed to overcome and also the provisions of the Bill itself.
My hon. Friend referred to the lack of sympathy shown by those who do not suffer from what must be a very unhappy affliction. Deafness in others has always, unfortunately and very unkindly, been a subject for a good deal of ill humour. We have gone a long way from the days when the cartoonist and the humorist, in order to get a laugh, showed an ear trumpet at a person's ear, and we are very grateful for the passing of those times. But deafness is an affliction which people are very unwilling to admit and they are reluctant to seek aid to remedy the affliction. Therefore, it is extremely important that great care should be taken to ensure that persons who wish to cure their affliction should be able to do so by resorting to deaf aids and other appliances. For that reason one welcomes any attempt to ensure that the standard of manufacture, training and discipline in the trade shall be high. I therefore welcome the attempt which my hon. Friend has made to establish a code of procedure.
I am sure that everyone will agree with the principle that underlies the Bill. I believe that the doubt which some may have is whether this is the right way of tackling the problem. I certainly agree with the suggestion of my hon. Friend the Member for Norwich, North (Mr. Wallace) that people ought more readily to seek professional and competent medical advice before resorting to manufacturers and suppliers of deaf appliances. It may be thought outrageous if I say that no one ought to be allowed to supply deaf aids and appliances except on the production of a prescription or a certificate from a member of the medical profession.
I am not qualified to speak on this subject, but I imagine that the initial stages of deafness might well hide other conditions which ought to be rectified first or, at least, in conjunction with the attention given to the deafness itself. I pass no criticism on a profession of which I know little or nothing, but I think that there may well be at least some firms which would not pay regard to side-effects or the possible presence of other defects not obviously apparent.
§ Mr. Pavitt
I am grateful to my hon. Friend for raising this interesting point. It is a point which I would have liked to cover in the Bill. The only reason why it is not so covered is that I have reached agreement with the trade and profession to exclude it; on that condition they will support the Bill. There it is.
§ Mr. Robinson
My hon. Friend is very frank in explaining what one might describe as horse dealing, if that be the right expression. Nevertheless, I feel that I could not accept such a compromise, even though it may have been a tactical one, because I believe it to be important in regard to not only deafness but all other conditions that those who are qualified to treat them should be brought into the picture at the earliest possible moment. Perhaps it is not too late to introduce a suitable provision in Committee.
I am not at all happy that the supply of appliances of this description, so important for the health and happiness of the people concerned, should be left to commercial exploitation. I would like it to be possible for deaf aids and other such appliances to be obtained only through the National Health Service itself or through institutions or organisations approved by the Minister of Health.
However, having said that, I acknowledge again how important it is that something should be done. My hon. Friend's Bill represents a comprehensive way to tackle the problem. In a debate on another subject one Friday not long ago, I spoke of the need for the professions themselves to control their own discipline and destiny. We must have some regard to whether we may be setting up too complicated a machinery to deal with a problem which, in my view, could be dealt with quite adequately through the National Health Service. One sees the necessity for registration of traders, but I hope that my hon. Friend will forgive my saying that I regard it as something of a defect in his Bill, as I read it, that there is no requirement that the trader himself shall in any way be professionally qualified or conform to any standards. Presumably, his qualification is the ability to organise and manage in order to reap the profit which may accrue to him from his business. 933 It is most desirable that anyone wishing to engage in this work should himself conform to certain professional standards or, at least, technical requirements. I should like to see this Bill as the basis for action in regard to all trades and professions so that people were registered and thereby subjected to rigid discipline if they attempted to take unfair advantage of their trading facilities and position.
It is good that the proposed council shall draw up a code of practice and, perhaps. standards and specifications of construction and durability to which the instruments and appliances should conform. Again, I should like to see this admirable provision extended in other directions. It is welcome, also, that provision is made in the Bill for standards of training to be investigated, and, more than that, for action to be taken to ensure that adequate training is available for those who engage in this important trade.
I have carefully considered the Clause regarding advertising, and I share the doubt expressed by my hon. Friend the Member for Norwich, North about whether any advertising should be allowed. I should have thought that it would be adequate if people were recommended through various sources to those who supply these aids. But it is very wrong, immoral and probably even a heinous offence to put into an advertisement statements which may attract people and give them a hope that their hearing may be cured when those advertisements are very exaggerated in their content.
In any event, if advertisements are to be allowed we ought not to shut the stable door after the horse has bolted. I should like to see any advertisement, which it is proposed to insert for these appliances, first submitted to the council for approval before it appears in public. In that way control could be exercised on advertisements without our having the risk of the advertisement already being seen by the public and perhaps wrongly persuading some people to buy an appliance which is of little or no value to them.
The Bill proposes to establish a disciplinary body which will have the right—a very serious right and one which must be exercised with considerable care—to remove people entirely from the trade which they are carrying out. This is a disciplinary committee, a provision 934 not uncommon in the professions, but I am a little doubtful, if we are not to establish a profession and not to establish professional standards of entry into it, whether we ought to have a disciplinary comittee which has these powers.
I apologise for making these criticisms, which I have tried to make constructive criticisms, because it is obvious that my hon. Friend has tackled a problem which needs to be dealt with urgently. I wish him well, if not in the Bill itself at least in the principle underlying it and in my hon. Friend's desire to see that these unfortunate people who are afflicted with deafness have a fair deal from those to whom they go.
§ 3.32 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)
The whole House is indebted to my hon. Friend the Member for Willesden, West (Mr. Pavitt) for introducing the Bill and for the moderation and thoroughness with which he addressed himself to the problem.
My object in intervening is to explain to the House to what extent there is a case on purely health grounds for the type of control over the hearing aid industry which he proposes. It is not my duty to go into other aspects of the problem or into the commercial arguments; I shall leave these to my right hon. Friend the Minister of State at the Board of Trade. What I say will, therefore, be necessarily brief.
I am sure that we all ought to have the greatest sympathy with the deaf. Their affliction, perhaps more than any other, cuts them off from their fellows. The unhappiness which this can cause and the difficulties of adjustment which may arise from the onset of deafness can be very great. To a deaf person, therefore, a hearing aid can be a life-line. It is thus no wonder that the subject of hearing aids, their performance, availability and method of supply is one which causes the strongest feelings. Those of us who came out of the war with our hearing to a limited extent impaired, for various reasons, know the anxieties involved and know how this potential development in our physical state affects our thinking.
The National Health Service makes provision for the deaf, and the Medresco range of hearing aids—first the valve 935 models and for the last few years the transistorised instruments—has been available since the beginning of the Service. These are body-worn aids, and there are some people who are not altogether happy with them for what are known as cosmetic reasons. But technically the Medresco aids are sound and afford a good performance, and they can help all save a very small minority of the patients who are capable of benefiting from any hearing aid at all. The position, therefore, is that the National Health Service helps all patients except a small minority. We are keeping under review the aids which we provide in the hope that we shall be able further to improve our service.
Only a few patients are thus obliged to resort to purchasing their hearing aids privately, so that the scope of this Bill is quite small. This is not to belittle what it aims to achieve, but it is important when considering it to remember that the National Health Service provides hearing aids without charge, of which the vast majority of patients can avail themselves if they so wish.
It might be supposed that an unsuitable or badly fitted aid might damage the user's health. I am assured—and I am addressing myself to the particular point made by my hon. Friend the Member for Norwich, North (Mr. Wallace)—that on the basis of the best specialist advice available, this is not so. The chances of any damage being done to an adult by wearing an aid which is not really adapted to his needs, or is badly fitted, or is even unnecessary, are negligible and can be dismissed.
Regarding children, a minority of doctors think that there might occasionally be a slight risk, but any risk that there may be is no more than marginal, and, in any event, children are well supervised by the school health service.
§ Mr. Wallace
There is this very important point of safety, particularly when the patient is walking about. If the hearing aid does not fit or work properly, there is a danger to the individual.
§ Mr. Snow
I take my hon. Friend's view on that. I was addressing myself to the long-term threat to a person's health. My advice is that a case cannot be made out for the Bill on medical grounds. 936 It is no doubt true that a deaf person who is sold an unsuitable hearing aid which does not properly meet his needs will have unnecessary difficulty in adjusting himself to his life in society. and this may have a bad effect on his general wellbeing. But this is the kind of problem which affects all sorts of people in all sorts of circumstances.
§ Mr. Pavitt
Can the Parliamentary Secretary say if there is any other person with disability to whom his remarks would apply?
§ Mr. Snow
No. I should have thought that this was peculiar to this problem. There are very few of us who have not, at some time or other, had personal experience of this problem in one form or another. It applies to almost any defect in the social environment, however created, for it is undeniable that social discomfort—or for that matter, any sort of social deprivation—may affect health, mental or physical, by direct or indirect means. These are very broad issues. They go right outside the health field as normally conceived, and they do not affect the firmness of my conclusion that a case for the Bill cannot be sustained on health grounds.
This is, to some extent, a side issue because, as I see it, the main arguments advanced by my hon. Friend and other hon. Members are not health arguments, but rest mainly on the need to protect a small number of people from the alleged undesirable selling practices adopted by some parts of the industry.
These issues do not come within the purview of my Ministry, but will be dealt with in due course by my right hon. Friend. I must confine myself to putting on record the advice which I have received, that a case for the Bill cannot be made out on specifically health grounds. I am sorry to have to emphasise this point, because I must confess that I was very impressed by the speech of my hon. Friend on the general need of the public for some sort of protection, to which I believe my hon. Friend will address himself.
§ 3.38 p.m.
§ Mr. A. H. Macdonald (Chislehurst)
I was interested to hear the remark of the Parliamentary Secretary that the Bill cannot be justified on health grounds. I 937 have never supposed that it was. I saw this Bill as an attempt to meet a disadvantage attached to the disability of deafness, to which almost all previous speakers have referred. I hope it is not an unkind way of putting it when I say that deafness is not taken as seriously as are some other disabilities.
By means of some form of regulation as set out in the Bill, this occupation will be raised to the status of a profession, and will be given a measure of dignity, which will be of great assistance to those who suffer from this disability.
§ Mr. Snow
I hope that my hon. Friend will not allow that impression to go out from here unchallenged. The importance that we attach to the Bill is very great indeed. Indeed, it is a matter of regret for my right hon. Friend that he could not come here today. For various reasons, including his long association with this matter with my hon. Friend the Member for Willesden, West (Mr. Pavitt), he would have liked, had he been able, to attend the debate. For what comfort it may be, there are my right hon. Friend the Minister of State, Board of Trade and I here representing the Government to express their viewpoint today. As I said, we attach a great deal of importance to this matter.
§ Mr. Macdonald
I am obliged for that intervention. I am sorry if my remarks gave the impression that I was being critical of what has been said.
My hon. Friend the Member for Willesden, West (Mr. Pavitt) referred to this as a small Bill. I cannot think why. Surely the importance of the Bill is measured not so much by the number of people affected by it as by its importance to the class of people involved, and I should have thought that to those who suffer from this disability the Bill was of considerable importance.
I want to make it clear that I congratulate my hon. Friend upon introducing the Bill because I want to turn, if he will forgive me, to one aspect that seems to require rather careful thought. I put forward these thoughts not in any sense suggesting that we should fling the Bill out now but rather in the sense that this matter should be given more detailed thought at a later stage. I refer to Clause 8, which sets up the disciplinary committee.
938 I fully acknowledge that if standards are to be established and maintained there must be some measure for enforcing them and ensuring that they are properly kept. Nobody could quarrel with that, and I do not. But I note with a little alarm the tendency in the Bill to make the profession a judge in its own case. This tendency seems to be common in the professions. It is the practice in the legal and medical professions; they have disciplinary committees which judge their own members. I am not too happy about this.
§ Mr. Pavitt
If I may correct a misapprehension, the disciplinary committee would consist of 50 per cent of persons not in the trade—representatives of the Consumer Council, the National Institute for the Deaf and so on; people not in the trade at all.
§ Mr. Macdonald
I am very much obliged. I readily concede that this makes the proposal somewhat less disagreeable to me than it might have been. But it does not entirely remove the unease that I feel about this sort of disciplinary committee.
Associated with Clause 8 is Schedule 2, which sets up the disciplinary committee. I congratulate my hon. Friend on the comprehensive detail that he has packed into it. It is clear that an effort has been made to make the proceedings just and reasonable—in other words, as much like those in a court as they can be. But I should have thought that in cases like this we should have gone the whole hog and used the courts. I do not like these private tribunals. I should have thought that there would have been a perfectly adequate role for the disciplinary committee in preparing a case, if a case were necessary, against anybody offending against the regulations, and that the case should then be brought in a court, where, of course, the proceedings are public. I am not clear whether the disciplinary committee will sit in public. I believe that the disciplinary committees of other professions do not always sit in public, and I regret that. If the livelihood of anyone is to be judged by a body of people, whether their peers or not, I should have thought it desirable that the body should meet in public.
To some extent my objections are met by subsection (4), which provides for a 939 right of appeal. This is desirable. But if there is to be an appeal to some higher court, I should have been much happier if the public courts of the country had been used in the first place. These are not objections of substance to the Bill but just objections on a point of detail, and I hope that they may be considered at a later stage, because, with that proviso, I should give a very warm and hearty welcome to the proposals in the Bill.
§ 3.45 p.m.
§ Mr. Marcus Worsley (Chelsea)
Every hon. Member who has taken part in the debate has congratulated the hon. Gentleman the Member for Willesden, West (Mr. Pavitt) on bringing the Bill forward, and on behalf of my right hon. and hon. Friends I do the same. Clearly, the Bill has a great deal of work behind it and the hon. Gentleman's speech reflected his great knowledge of the subject and the great amount of work that he has done.
Indeed, he has had the rare compliment paid to him of drawing two Ministers to reply to his speech. This is quite something and we look forward to hearing the second Minister. After the events of this week, we hope that he will say something quite different from what his colleague said.
§ Mr. Worsley
If the right hon. Gentleman reads HANSARD for the last few days, he will see why.
My main purpose is to welcome the Bill on behalf of the Opposition. The hon. Member for Willesden, West said that it is an uncontroversial Measure between the parties. Indeed, three of my right hon. and hon. Friends have joined with him in sponsoring it. Time is getting on and we are anxious that the Bill shall get a Second Reading, so I would merely say that we shall do what we can to facilitate its passage, if it should get a Second Reading, and will help it in Committee and try to make it, as he indicated, a better Bill.
The hon. Gentleman was very modest. He said that he thought improvements could be made to the Bill and we have some points to make. We cannot, I am 940 afraid, hope to provide what he really asks for—namely, a new pair of ears—but we will at least help him if we can to produce a better Bill. With those comments, I leave the debate to the second of the duo of Ministers.
§ 3.48 p.m.
§ The Minister of State, Board of Trade (Mr. George Darling)
I shall be brief. I join in the congratulations to my hon. Friend the Member for Willesden, West (Mr. Pavitt) upon the hard work that he has put into the Bill. My hon. Friend the Parliamentary Secretary to the Ministry of Health has told the House that, in the view of the Ministry, there are no medical grounds for the Bill. I cannot express any views on that aspect. The question that remains is whether the Bill therefore comes within the purview of what we call consumer protection, which is where I come in.
I go all the way with my hon. Friend the Member for Willesden, West in condemning the kind of high-pressure salesmanship he has described. Anyone who misrepresents the goods he is selling and dishonestly impresses people to buy them deserves condemnation but when he is practising fraudulent activities upon deaf people his behaviour calls for the utmost condemnation.
There are two points in the Bill which give us a great deal of concern from the point of view of consumer protection. One is the setting up of what I must call a professional body, despite my hon. Friend's plea that the proposed council would be unlike any existing professional council and that, because it would be set up in a peculiar, indeed, unique fashion, it should not come within the terms of reference of the Monopolies Commission in its inquiry into professions.
I cannot agree with him because, if the Ministry of Health found good reasons for supporting the setting up of a council of this kind for medical reasons, it would be a professional body in the ordinary sense of the term and there would not have been such strong arguments for not accepting it. But, in view of the Ministry of Health's attitude, we would be very reluctant indeed—and I speak now for the Board of Trade—to set up an additional professional body before we had the Monopoly Commission's recommendations on how professional bodies or quasi-professional bodies 941 should be organised, what their standards of competence should be, how their rules and standards should be enforced, and so on. Therefore, we would hope that such a council, whatever its merits might be, would not be set up for the time being.
Another factor is that dealing with the control of advertisements and the way in which it is proposed that the council should receive complaints from the public and investigate claims and deal with them and so on. There is a time factor, because as the House knows, we intend to bring forward the Protection of Consumers Bill, a Bill which was introduced in another place before the General Election and which will be reintroduced as soon as possible. The purpose of the Bill is to bring together and revise the many confusing and quite inadequate pieces of legislation now on the Statute Book which aim at protecting consumers from disreputable trading practices. The last things we want are any further bits of legislation which would have the effect of removing control and enforcement over parts of consumer protection from the comprehensive arrangements laid down in the Bill which we intend to reintroduce as soon as possible.
I am convinced that the measures within that Bill will do all that my hon. Friend wants to do to protect the customer from misrepresentation, from high-pressure salesmanship and the rest. I do not have time to spell this out, but I can assure my hon. Friend that appropriate parts of that Bill will do the job which he wants done about advertisements and high-pressure salesmanship.
§ Mr. Pavitt
Having examined that Bill, I can assure my right hon. Friend that, unless the Bill is very much altered, it would specifically not cover the cases which I have in mind.
§ Mr. Darling
I am sorry, but I disagree with my hon. Friend. If he proves his point, obviously we shall have to do something about the Bill. However, let us assume for the time being that the Bill will do what I have said. We then come to the time factor. If we could get our Bill on the Statute Book within a reasonable time, not too far ahead, we should be able to deal with this problem far more quickly than if it were left to a council set up under my hon. Friend's Bill.
942 There is a further consideration. In addition to the consumer legislation which we intend to bring forward, we have given a Third Reading to the Misrepresentation Bill which will help in certain cases in which civil action can be taken to recover damages for misrepresentation. These two Measures together, the Protection of Consumers Bill and the Misrepresentation Bill, will deal with dishonest salesmanship far more quickly and far more effectively than would be possible under the Bill which my hon. Friend is asking the House to approve.
§ 3.55 p.m.
§ Mr. R. W. Brown (Shoreditch and Finsbury)
To some extent I am rather disappointed with the replies that we have received in this debate. I do not quite follow how, as my hon. Friend the Parliamentary Secretary has said, if a hearing aid is fitted badly and requires constant attention and repositioning, causing inflammation of the inner ear, he can claim that that does not affect a person's health.
He was correct in what he said about the National Health Service. It provides hearing aids, but one of the difficulties there is the repair service. People to whom I have spoken tell me that the service is disgraceful, that there is a long waiting period and because of the pressure upon the technicians, the aids do not receive proper attention. I have heard of cases where people have had to send the aids back two and three times, and finally finish up with a hearing aid which is not doing a proper job. Then they have to turn up the volume and they get a whistling noise, so that when they are sitting around the family circle listening to television there is this whistling noise going, on. Sometimes the television is blamed.
Can the system be improved? I understand that it will cost money but these people ought to be given the best possible service. I do not believe that people deliberately set out to defraud, as was perhaps suggested by my hon. Friend the Member for Willesden, West (Mr. Pavitt). Manufacturers attempt to influence people.
§ Mr. Brown
I was coming to that. But to deal with advertisements, I do not think that manufacturers are attempting to defraud, they are encouraging people to buy a better quality set. I would draw the attention of my hon. Friend the Parliamentary Secretary to what is being said in these advertisements. The advertisements suggest that it is all very well a person having a National Health Service aid but they are not as good as the sort that manufacturers can provide.
This is rather like spectacles. People are encouraged to have different frames to those provided by the National Health Service, because they are led to believe that the N.H.S. type is not good enough. This is the sort of thing which is being said about hearing aids. People are being persuaded that if they purchase more expensive equipment in some way this will give them a better result. Sometimes this is true but not always.
Because of the trouble to which I have referred, and the repairing of these aids, people fall for this line, believing that it would be better to have such equipment. It is not so much a matter of trying to defraud, but persuading people that they can get something better if they are prepared to pay more. I do not object to that if it were true, but I am advised that many of the hearing aids costing more do not show any sign of being a better piece of equipment than that supplied by the National Health Service. The Bill is of some merit if we can draw attention to a code practice which will put an end to this type of scheme. Like the hon. Member for Chislehurst (Mr. Macdonald). I was very worried about the suggestion for the setting up of a disciplinary committee—
§ It being Four o'clock, the debate stood adjourned.
§ Debate to be resumed upon Friday, 17th March.