§ 2.0 a.m.
§ Mr. Ronald Bray (Rossendale)
I acknowledge the tolerance of the House in permitting me to raise at this late hour the question of the provision of a better service for the deaf. This debate originates from the statement made on 9th July 1973 by the then Secretary of State for Social Services, the right hon. Member for Leeds, North-East (Sir K. Joseph), in which he stated that a behind-the-ear type of hearing aid would become available under the National Health Service. Up to then, the only issue of hearing aid was the body-worn aid, or what was irrevertenly called the "bosom-basher" hearing aid, which had its origin in about 1948. It would be for the benefit of the House if I gave briefly the background to events in the interim period.
From 1948 until 1973—over 25 years—the only National Health Service hearing aid was of that type. The hearing aid industry which developed over the intervening 25 years and which currently has 170 dispensers and 1,500 people engaged in the production of hearing aids in this country, developed and produced several varieties of hearing aids, behind-the-ear and of similar pattern, of much more sophisticated design. The people in the industry endeavoured to make good the deficiency in the style of aid offered by the National Health Service, both in its sartorial effect and its overall efficiency. This they did with a certain degree of satisfaction. It can be seen from the figures for sales or prescriptions provided by these people that they produced something that people wanted which was much more attractive than the aid offered under the National Health Service.
The industry, however, had its disadvantages. It had what we might term its "cowboys"—those who sold where they could and how they could, and who abused this section of the industry. To offset this, the dispensers and consultants set up their own trade association, which endeavoured to discipline or to police the industry. The association has done that with a reasonably high degree of satisfaction both to the industry and to its customers. There is also a manufacturers' association which until recent months was independent of the dispensing side or the 441 consultancy side of the business. I emphasise that from the increased sales of their products—"sales" is the operative word in this case—it must appear that those who suffer from being hard of hearing were fairly satisfied.
As a result of the Minister's statement in July 1973 there were two meetings with the trade associations. The first was in August and the second in November, with the then Under-Secretary. At the first meeting the trade was asked what services it could offer, what sort of distributive system it had, and so on. The second meeting was wholly unsatisfactory. It amounted to more or less saying, "Thank you for coming last time, nice to have met you, goodbye." In other words, the associations were not consulted on what virtually amounted to notice to quit.
It was at this juncture that I was involved, as a direct result of an approach by a constituent of mine, Mr. E. Slater of Rawtenstall, who is a consultant in hearing aids and a hard-working and honest man if ever I met one. I wrote then to the then Secretary of State about the matter, saying:The difficulty is that the private sector of the hearing aid industry in so far as audiologists are concerned will be put out of business since all hearing aids will ultimately be supplied through the hospital service. Whether the consultants give good or bad service, whether they like it or not, their livelihood has been taken from them. I would respectfully suggest that this is one step towards a national health service which will in due course eliminate freedom of choice and the private sector—it is logically very unlikely that these consultants will be able to find sufficient private practice to exist, much less remain in business! Obviously the majority of the consultants have great experience, are well qualified and have served the community beneficially over a number of years. If this is to be the policy of HMG for hearing aids, then surely it is not unlikely that it will be extended to other beneficial services and equipment supplied exclusively through the NHS.I shall be pleased to hear what action the Department propose to take to safeguard the consultants, that the fears of the Hearing Aid Industry Association are unfounded, and that there will be no further inroads by the Department into the private sector. A number of hon. Members from both sides have received what can only be described as a brushoff reply. As a result of that I tabled a Parliamentary Question asking for a complete list of hearing aid designs 442 approved by the Department for the National Health Service. The reply was more than slightly offputting. I was told by the then Under-Secretary thatMy Department has so far approved two behind-the-ear hearing aids for general issue through the National Health Service. One, model OL67 manufactured by Oticon Ltd., in Denmark, is currently supplied to school children. The other, which will be the first of this type to be issued to adults, will be available next year and will also be manufactured by Oticon Ltd., but in a development area in Scotland."—[OFFICIAL REPORT, 12th December 1973; Vol. 866, c. 140.]I was also advised that the Department would not be offering existing or other private qualified consultants contractual employment but that these people would be given the chance of employment in the health service as dispensers provided they met the requirements of the Whitley Council. I suggest that that is not in the least a satisfactory answer, bearing in mind that some of those consultants have been in the industry and the profession for 25 years.
I followed with a further series of Questions, and on 20th December I received a reply to a Parliamentary Question in which I asked for a register of qualified consultants or qualified audiologists and I was advised that the Department did not maintain such a register. Perhaps I am very thin-skinned, but I took a dim view of that reply because what it did not tell me in answer to my Question was that the then Department of Trade and Industry maintained such a register. The Department of Health and Social Security were not being, to say the least, helpful.
On the same day I asked another Question of the Secretary of State for Social Services—whether he wouldprovide facilities for British manufacturers to tender for the supply of all types and models of behind-the-ear hearing aids approved by his Department".The reply read:British manufacturers were able to tender and a number did for the behind-the-ear hearing aids to be supplied through the National Health Service. Some tenders are still under consideration and an opportunity remains for these manufacturers to submit models for approval and supply."—[OFFICIAL REPORT, 20th December 1973, Vol. 866, c. 377.]There is, however, another issue arising, namely, that a contract had already been placed with Oticon, in Denmark, on 28th 443 November, for these identical hearing aids. In other words, somebody, somewhere, was misleading. Three weeks or so had gone by and this information was not available.
There is another factor still—that the British manufacturers can offer at least the same manufacturing facilities as those of the Danish company. They can go further. They do not require Government finance for a factory in a development area in Scotland for these bits and pieces to be made.
Such was the picture. I suggest that the Department was less than frank right through the issue. I have already detailed the information as to the numbers ordered. It was 150,000–60,000 in the first year and 90,000 in the second. I am given to understand that there are no further contractual arrangements with Oticon but I do not feel that it was in any way fair that the Department should overlook British manufacturers in this matter.
Now we come to the main issue—is the Department of Health and Social Security fully equipped and able to meet the needs of the service? What we all want—I am sure that the Minister will confirm this—is to give first-class service to the public as a whole.
One point must be put on the question of the register: I should like confirmation of the fact that the Oticon units offered are suitable only for the medium-deaf and not for those seriously affected. As a layman, I am given to understand that those who are medium-deaf or less can have surgical or other remedial treatment, which would perhaps dispense with those types of equipment.
In a letter which I received in February from the then Under-Secretary I was told that the whole of the distribution would be effected by the National Health Service, which, on its own admission, was short of staff qualified for the purpose. I do not see why it is necessary to give those who work in the Department a slap in the face, which is what the methods adopted amount to.
On 25th March this year, a departmental circular, reference H/D11/01, was sent to area health authorities. Completely contrary to the information which has been given, it suggests that the autho 444 rities should make a deal with the private sector and ask it to assist in the provision of hearing aids. It says:If the necessary fitting skills are not available within the National Health Service, the dispensing of these aids should be carried out by dispensers registered under the Hearing Aid Council Act 1968. Local arrangements for this purpose should be made by Supplies Officers, subject to the approval of the Otologist.That is a complete reversal of procedure. The circular, which came into my hands by accident also says:Some children will be suited only by other types of special hearing aids and it will be necessary for these to be purchased from and fitted by private dispensers. Local arrangements for this should be made by Area Supplies Officers on the recommendation of an Otologist.We have a reversal of policy there.
Everybody wants to give the best possible service to the deaf—to those who are not so well placed in life. What I do not understand and do not like is the attitude that this will be a 100 per cent. National Health Service matter. There may be a political slant; I do not know. The National Health Service admits that it does not have all the dispensers. It may not have all the ear, nose and throat specialists available to recommend. Therefore, it goes back on what it said previously, and says very quietly to the area health authorities, "Make a quiet deal with private practice. Use it while you can, and when you are equipped to do the job yourselves throw it overboard." That is the impression created by this correspondence. I hope that I am wrong in my assumption.
I should like to see arrangements similar to those in certain European countries, whereby the otologists continue to operate in private practice, but the recommendations are made to them by the ear, nose and throat specialists. They are told, for example, "Mr. Smith requires this type of equipment, and you are authorised to supply it".
There is also the question of servicing, of replacing batteries, and so on. I understand that the National Health Service would not object to the private sector's supplying replacement parts. I advocate a partnership between those who have given good service over the years—many of them are small independent practitioners—and the National 445 Health Service. By team work we can achieve the results to which we all look forward. I hope that the Minister will support my plea.
§ 2.20 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
I must compliment the hon. Member for Rossendale (Mr. Bray) on his choice of subject tonight, for it is of great interest to many right hon. and hon. Members. I am glad of the opportunity of the debate because—let us face it—in the past, the services for the deaf, not being one of the glamorous areas of health care, have been somewhat neglected in the National Health Service.
My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), who is tragically, completely but triumphally deaf, had hoped to be here for the debate, but this has proved impossible because of a commitment tomorrow morning to which he was firmly pledged before the date of the debate was announced. I know that the hon. Member for Rossendale and the whole House will agree with me that my honoured and hon. Friend notably personifies not only the courage and fortitude but the determination of the deaf to overcome a grievous disability.
I take personal pleasure—indeed, I rejoice—in my hon. Friend's close association with my Department as Parliamentary Private Secretary to my right hon. Friend the Secretary of State. My right hon. Friend herself is, as the hon. Gentleman will appreciate, deeply and most genuinely concerned with the problems with which deaf people have to contend. My colleague—my hon. Friend the Member for Brent, South (Mr. Pavitt)—is here for the debate. He, too, is much respected for his triumph over severe disability and his abiding concern for the welfare of the deaf and all who are afflicted by hearing difficulties.
The hon. Member has spoken about the new National Health Service behind-the-ear hearing aid for adults which, to their credit, the last Government decided to introduce. I shall speak of this in a moment, but first I must say that we are not concerned simply to issue a new kind of aid it is our aim to improve the whole standard of service provided for those with hearing impairment. This 446 means better ways of identifying them, of treating conditions which may respond, and of assessing each patient's hearing impairment and its implications for his social and economic functioning.
Audiology departments need improvements in the design of buildings, in standards of accommodation and equipment and, not least, in the kind and quality of after-care and rehabilitation that they provide. Of course, we all know that it is not enough just to hand out a hearing aid. The user needs help—in some cases, over a considerable period—so that he can learn not only how to operate his aid, but how to exploit its full potential and make the best use of his residual hearing. He may also need training in lip-reading and, perhaps, speech therapy.
The quality, effectiveness and availability of these follow-up and educational services will make all the difference for hearing aid users in helping them to get continued good service from their aid and adapt successfully to their hearing loss in their daily lives. All this serves only to show what a major programme we are embarking on—and hon. Members will not need me to stress that, with present resource limitations, it will take some years before we can hope to achieve the comprehensive, district based service which is our ultimate objective.
We are anxious that, in spite of their current financial problems, National Health Service authorities should develop these services as a matter of urgency. We have, therefore, just decided that, although it must remain a local decision what priority can be given to them in the light of competing demands on resources, we will exceptionally make available a small amount of finance above the ordinary allocations to health service authorities to supplement the financing of some essential projects which could otherwise not be undertaken.
The Medresco range of hearing aids has served the deaf well, and will continue to do so, but it was only a matter of time before behind-the-ear hearing aids which could be worn unobtrusively were available without charge. It was, therefore, with considerable pleasure that the House heard the announcement in July last year by the previous Secretary of State for Social Services—the right hon. Member for Leeds, North-East (Sir K. Joseph). 447 In order to get the new programme off the ground in the shortest possible time, it was decided to utilise tried and tested aids of commercial design provided that they conformed with an up-to-date technical specification prepared by my Department and its expert advisers. It was envisaged that more than one supplier would be needed for the quantities involved. Invitations to tender were sent to all manufacturers in the United Kingdom, EEC countries and elsewhere who had expressed an interest and who were thought to be in a position to offer suitable aids.
As a result of this competition, one contract has so far been placed with the Danish company—Oticon Limited—which has a world-wide reputation as a designer and manufacturer of hearing aids. Although the company's aid is of Danish design, it is being manufactured at a new factory opened specially for this purpose in the Scottish Development Area. When in full production, 60 new jobs for British work people will have been created. The award of further contracts within the next few weeks is planned, and revised quotations from other tenderers, which include British firms, are in the final stages of examination.
The addition of this new aid will attract many more people to health services, and it is estimated that about a million people in the whole country could benefit. This represents a considerable extra commitment to the National Health Service, not only in terms of money for the aids themselves but in highly-trained staff, accommodation and equipment. To allow time for the services to develop to meet the additional burden it was necessary to adopt a system of priority, and in the first year, starting in November, priority is being given to war pensioners who require aids for their accepted disabilities, mothers with children below 5 years of age, children and young people receiving full-time education or whose aid was replaced by a body worn model on leaving school, and people with exceptional medical need or with an additional severe handicap such as blindness. The priority groups for the second and subsequent years are being considered.
The hon. Gentleman has spoken about the possibility of using the expertise of the private dispensers of hearing aids. 448 Many private dispensers have written to us, and members of the Hearing Aid Council have discussed with the Department the possible effects of a decline in the private sector. The previous Government considered this, and so have we. We are convinced that what hard of hearing people need is not merely a service which dispenses hearing aids but a comprehensive service concerned with medical diagnosis follow-up and rehabilitation as well as fitting the aid, with all of these aspects under consultant surveillance. In the circumstances the decision taken by the previous Government to go for a hospital based service was inescapable and I agree absolutely with their conclusion.
Private dispensers have asked why the provision of hearing aids could not be treated in the same way as spectacles, and at first glance this is not an unreasonable request, but it does not hold up to closer examination. The fitting of a hearing aid is not the same as fitting a pair of spectacles, because hard-of-hearing people need to be educated over sometimes quite considerable periods in the use of their aids. We regard the actual fitting as part of a continuous process and not capable of being divorced from the other parts of the service. There would have to be a separation of diagnosis, prescription and follow-up from dispensing with the result that the hospital dispensing service would not develop and the goal of a comprehensive service would be lost.
There are other important factors—namely, cost and the distribution of services, and I can hold out no hope that the private dispensers will be brought in to the new arrangements. In saying this, I am not casting any doubt on the standards of practice of the private dispensers registered with the Hearing Aid Council. Together they constitute a body of great skill who have provided and, I am sure, will continue to provide a service of value to the deaf population. There will be a place for them, partly because many deaf people will not for the time being be suited by National Health Service aids even when the new headworn aid is introduced—as I have said, it will take a long time to make the National Health Service fully comprehensive—partly because no doubt private industry will pioneer new devices, and partly because many deaf people will in any case prefer to use the private sector.
§ Mr. Bray rose—
§ Mr. Morris
If I am to reply to the debate we shall have to be quick, as I understand we are now pressed very hard indeed for time.
§ Mr. Morris
That anticipates a point that I was hoping to make.
The development of a comprehensive service is our objective, but obviously improvements are going to take some considerable time, particularly in view of the strains on existing National Health Service resources. Though the number of technical staff is growing year by year, it is not evenly spread and there are local difficulties of recruitment. There was in Great Britain, prior to the recent reorganisation of the National Health Ser 450 vice, the whole equivalent of about 390 physiological measurement technicians—that is audiology—including students, working in hospitals. My Department has advised authorities that over the country the aim should be to secure a net increase of 20 per cent. this year in staffing levels and a doubling thereafter. There are areas which are poorly provided for and the increase would need to be higher in these places. The Department has been examining the need for additional training arrangements to meet increased recruitment and the introduction of new types of hearing aid—
§ The Question having been proposed after Ten o'clock on Tuesday evening and the debate having been continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at half-past Two o'clock a.m.