§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Coleman.]
§ 8.0 p.m.
§ Mr. William Whitlock (Nottingham, North)
Whenever in the past I have been granted the opportunity to raise a matter on the Adjournment it has always been very late at night or early in the morning. I am very glad that on this occasion we have reached the Adjournment early and I hope that that augurs well for what I shall propose and that my hon. Friend finishing his tour of duty earlier tonight than he might otherwise have thought, 321 will look more kindly at the points I shall put to him.
Deafness is affliction little understood by the public in general. It is, therefore, a disability which attracts little public sympathy, and because it attracts little public sympathy little pressure is exerted upon the powers that be for better services of all kinds for those who suffer hearing impairment.
I wish tonight to point to the need for these better services. In my constituency is the Ewing School for the Deaf, and each time I have visited it I have been deeply moved by the wonderful rapport which exists between teachers and pupils. Truly, the teachers of the deaf are in a special category, and I am grateful for this brief opportunity to pay tribute to them.
But lest my hon. Friend the Minister should feel that I am straying into areas not his concern let me point out that my contact with this particular school has led me on to look into a number of problems associated with the deaf over the years. Because organisations catering for the deaf apparently became aware of my growing interest, several parents of deaf children in Nottinghamshire approached me last year to express their concern about the educational services for the deaf.
It would have been easy to dismiss these complaints, somewhat vague and indefinite as they were, as just emotional expressions of the understandable desire of parents for the best possible service for their children. But I felt that the complaints were justified. Parents felt that all was not well, that the best use of what was available was not being made, and that there were differences in treatment for children in various parts of the county after local government reorganisation. All this led me to the belief that there was no common philosophy operating throughout Nottinghamshire in educational services for hearing-impaired children, and that there was a need for a uniform approach.
I asked for, and was granted last June, a meeting with various officials concerned with the teaching of the deaf in Nottinghamshire, and at that meeting there appeared to be agreement on the need for a unified comprehensive educational service for hearing-impaired children. Al- 322 though I have corresponded with the county director of education since that meeting a year ago, I have had no indication yet of the outcome of the county education committee's consideration of the matter. Indeed, in March this year the director of education told me that the offices of his department were so grossly overworked that it had not been possible for a paper to be prepared for the consideration of the education committee.
I have given these details not because my hon. Friend has any responsibility for education but in order to point out that in education there is no adequate uniform service for hearing-impaired children, and in order to go on from there to show that the inadequacies in the education service are linked with similar inadequacies in other services.
Increasingly I have come to realise that there is a need for better supportive services for the deaf over a wide range, because hearing impairment cripples its victims socially, psychologically and vocationally. There are varying degrees of hearing impairment and there are a number of causes of it, not all of them known, so that there is also a need for more and more research into the causes of the disability and its treatment.
From what I have gathered from my reading on the subject I understand that approximately one in every thousand very young children has a severe impairment of hearing. A further two per thousand have a lesser degree of hearing loss. In spite of the increasing knowledge of the causes of hearing-impairment in children, the numbers of schoolchildren with defective hearing are increasing, I understand. It would seem, therefore, that unless we devote more attention to this problem we are destined to have ever larger numbers of people who will not be able to realise their full potential because of their hearing handicap, and who will therefore fail fully to enrich their lives and to make a full contribution to their community's prosperity and well-being. Already statistics suggest that there are almost 2 million adults in Great Britain with a significant hearing loss.
The figures I have given on hearing difficulties for both adults and the child population indicate the size of the problem. In spite of the size of that problem, it has come as a shock to me to find 323 that not all children are screened as to their hearing capability at an early age, as they should be, and that of those who are screened some have hearing defects which are not detected until a later stage, because not all health visitors are adequately trained to make expert diagnoses.
That is a deplorable state of affairs. As one of the reports issued by a committee of the Department of Health and Social Security states:Delay in diagnosing any degree of hearing impairment in young children is of grave significance, for it can have permanent and far-reaching consequences on the learning of language, and it is likely to cause impairment of intellectual, emotional and social development. Prompt detection is essential if the best use is to be made of the early years. which are crucial for the child's development of language and speech. The infant under a year old is effectively laying the foundation, both auditory and in control of skilled movement, for speech to begin to develop soon after the first birthday, and it is therefore essential to avoid delay in overcoming any remediable handicap.Right at the outset of a child's life, then, we have defects in our services which cause hearing impairment in some children to remain unsuspected and undetected for so long a period that full retrieval of the consequent loss in the child's development is impossible.
It is, however, not only at the beginning of a child's life that our services have been inadequate but at various other stages as well. As I began to become increasingly aware of this, I found that the North Nottingham Community Health Council was giving close study to the problem, as were the other community health councils in Nottinghamshire. Between them they have recently produced a working party report on the services to those who suffer from hearing loss.
Still more recently, I have discovered also that the Advisory Committee of the Department of Health and Social Security has been considering all these matters Therefore, there is hope for the future that in this concentration of attention upon the gaps in our service for the deaf we shall find the necessary answers.
What all these investigations point to is the necessity of there being total child population screening at an early age, expert early diagnosis of hearing impairment, and speedy reference to specialists in appropriate cases. An adequate sup- 324 ply of hearing aids is another must. I have discussed in the House in the past the delays in the supply of hearing aids, and there obviously must be a minimum of delay between prescription of the correct hearing aid and its supply. There must also be readily available maintenance of hearing aids, including the changed moulds necessitated by the fact that children's ears grow rapidly.
The more one studies the problem of deafness, the more one realise that there must be a comprehensive, multi-disciplinary approach to it if we are to enable our children and our adult citizens to reach their full potential in life. Since my own thoughts began to point me in that direction I have found that the community health councils in Nottinghamshire and the Advisory Committee of the DHSS share the view that there should be available for centres of population, preferably under one roof, multi-disciplinary assessment, treatment, and rehabilitation facilities. These centres should be staffed with such specialists as medical audiologists, otologists, psychologists, psychiatrists, paediatricians, audiometry technicians, and other specialists necessary to complete such a comprehensive team.
Through that centralised provision there should be a continuing and complementary relationship with others, such as social workers, the teachers of the deaf, hearing therapists, health visitors, resettlement officers and so on. Parents of the deaf, inevitably so very emotionally involved with the problems of their children, need to know clearly to whom to turn for advice on how best they may help their children's development. Such a multi-disciplinary unit would provide that kind of support.
For hearing-impaired adults there should be made available through such a multi-disciplinary unit the kind of rehabilitation and support facilities which will ensure that their handicap does not drive them into such depths of loneliness, isolation and despair that they give up all hope of being able effectively to cope with the problems of their special life as deaf people. The easily accessible range of support and guidance which can be obtained for hearing-impaired adults will assist them to build up sufficient morale and confidence to face problems which 325 have previously seemed to them to be insurmountable. Unfortunately, there can be few parts of the country where such comprehensive services for the deaf exist. We must aim to supply those comprehensive multi-disciplinary services as soon as possible.
Some time ago I found that there was to be set up a National Institute of Hearing Research, and I asked that it be sited in Nottingham. I am very glad to say that it is now sited there. I believe that this is the first of this kind of institution in the world, and from this we should gain very much, particularly as it is headed by a very distinguished director, Professor Mark Haggard. The fact that we have this institute in Nottingham means that we have the ideal opportunity there to bring into being those multi-disciplinary facilities which I have mentioned and to bring them into close association with the National Institute of Hearing Research.
If that were done we should have in Nottingham something which might be described as a pilot scheme, which would provide the answers to many problems, and valuable guidance for dealing adequately on a national basis with the scourge of deafness. Such a comprehensive unit may not have been planned on the Nottingham Medical School site, but I hope that my hon. Friend will be able to say that he will give favourable consideration to my suggestion.
In the whole time that he has been in this House my hon. Friend has shown himself to be passionately and intensely interested in the problems of the disabled. He has campaigned for many years for improvements in the services to the disabled. In his present position he has achieved very much. If he can now add to those achievements the setting up of this scheme that I have suggested as a possibility, I feel sure that he will add a great deal of lustre to the crown which he wears as the Minister responsible for the disabled.
§ 8.18 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
I am most grateful to my hon. Friend the Member for Nottingham, North (Mr. Whitlock) for having initiated this debate. Moreover, I congratulate him on the obvious sincerity of his concern 326 to help deaf people, and even more particularly deaf children. He spoke not only sincerely but powerfully and movingly. He will readily appreciate that I entirely share his desire for further improvement in both the welfare and general quality of life of deaf people.
As our consultative document on priorities for health and personal social services in England makes plain, it is the Government's view that the needs of hearing-impaired people command a high priority, and justly so. We have made this clear on many occasions, but this debate provides an opportunity to reiterate this once again in the House, and I gladly do so now.
Before referring to Nottinghamshire itself, I should like to say something about the ways in which we have taken action generally to improve provision for deaf people and about our future plans. We make no claim to having achieved dramatic solutions to the difficult problems that face us, but, given the daunting economic situation that we have had to face, we have made very fair progress to date.
Perhaps the most significant aspect of this has been the progress made in providing the new behind-the-ear hearing aid, which we are making available to hearing-impaired people on a priority basis. We are at present considering how this convenient and cosmetically attractive aid, of which some 200,000 have already been issued, can be provided for everyone for whom it is suitable. I should like to emphasise that the aid will not suit everyone suffering from a hearing loss, especially those with severe deafness, but it does benefit people with a moderate degree of deafness.
I am fully aware that there is a demand for a more powerful aid of this kind to be provided under the National Health Service, but it is in the language of priorities that I must speak tonight and we are concentrating first on improving the present level of service and expertise. The present range of aids enables patients to exercise a choice, however, not only between a body-worn and a behind-the-ear aid, but between two models of behind-the-ear aid. I believe the fact that patients are given the aid of their choice will have a significant effect on the degree to which aids are used. We shall, of 327 course, proceed as quickly as we can to make the new aid available to both existing and new patients. I hope to be able to announce the arrangements for this in the near future.
In anticipation of all the additional work that will be placed in hearing aid centres by the quickening change from body-worn to behind-the-ear aids, the health authorities have been encouraged to recruit additional technicians and to improve facilities. To help authorities with the consequent additional expenditure, £500,000 from special funds was made available from 1974—of which the Trent Regional Health Authority was allocated £85,000—and one effect of this has been a significant increase in the number of technical staff in hearing aid centres and audiology departments generally.
In the period from 1971 to 1975—the figures for 1976 are still awaited—the number of technicians under training in England and Wales more than trebled, while the number who had successfully completed their training increased by nearly 50 per cent. These figures show clearly that, in taking on and training more staff, the health authorities are making meaningful efforts to improve the quality of their audiology services. There is no doubt that the very encouraging progress made in the five-year hearing aid programme for phasing-in the new aid has been due largely to the hard work and good will of staff at hearing aid centres. I am glad to have this opportunity to pay tribute to the service that they give.
Although the introduction of the new hearing aid represents a substantial commitment on the part of the Government and the NHS, I regard it only as the starting point from which a number of new measures will flow. I have recently received from my Advisory Committee on Services for Hearing Impaired People three reports concerning specific areas of service. Copies of these reports have been placed in the Library. They cover certain aspects of services for children and adults and are at present the subject of consultations with the health authorities and with various professional and voluntary bodies.
Thus it is too early to forecast the extent to which it will be feasible and 328 desirable to put their recommendations into effect. We shall need to look very carefully, of course, at the order of priority for determining the way in which the audiology services will develop in the years ahead. I have, however, already announced that, so far as the report on rehabilitation is concerned, I am prepared to make available limited funds to assist in the establishment of a new class of worker in the National Health Service to be known as a "hearing therapist".
For far too long hearing-aid users have not been able to receive the more advanced degree of follow-up necessary for those with a severe hearing loss or with special difficulties. We regard the hearing therapist as an essential part of a comprehensive service, who will help deafened adults to improve their communication skills and act as a co-ordinator of other means of help.
Another aspect of services that concerns me at the moment—and one on which my Advisory Committee has also made recommendations—is the screening of young children for suspected hearing defects. My hon. Friend referred to this important matter when opening the debate. If a condition cannot be prevented, it is of paramount importance that it should be detected at the earliest possible moment. It is especially important that a hearing loss should be diagnosed at a very early age, for failure to do so can have grave and far-reaching consequences on the acquisition of language. We shall be studying comments on this report alongside the recommendations of the Report of the Committee on Child Health Services—the Court Report.
I shall be saying something more about this later in the context of Nottingham, but I wish to emphasise now that I have been encouraged to learn all parts of the country have adopted the principle that all children should be screened for hearing at about 8 months and again at the age of school entry. Regrettably, this policy has not yet been put into practice in all areas and I shall be considering what further action is necessary to achieve an improvement in the position in the light of our present consultations. Our evidence suggests that things have improved over recent years, but I believe my concern that screening practice should match agreed policy is shared by those 329 responsible for organising and delivering this service.
I have already referred briefly to the change-over programme for users of body-worn hearing aids wishing to try out the new behind-the-ear aid. The next step is to make a start in replacing the current models of body-worn aids, which are no longer representative of present-day technology. Work has already begun on a replacement for the more powerful range of these aids and we are planning to replace the three existing aids with a single model. This work load will be additional to the current programme and will represent a substantial commitment to be fitted in when hearing-aid centres are able to take it on. This improvement will benefit deaf people of all ages and is, of course, over and above the wide range of commercial hearing aids that are currently available to children under the National Health Service.
In addition to the provision of hearing aids and related hospital services, my advisory committee has also been looking at the role of social services in the care of the deaf. I hope to be able to make its report available in the very near future, but I can say now that it is apparent from the extensive inquiries the committee has made that social services for this group of handicapped people are patchy. Some areas have very good services, while others have none at all specifically for the deaf and hard of hearing. Here, too, there is an increasing awareness that much more needs to be done. The report does not recommend any startling changes, but seeks to adopt a commonsense approach to present-day problems by identifying the tasks to be tackled and those best equipped to tackle them. I believe that the report will provide valuable help to authorities seeking to improve the quality of their services at a time when the scarcity of resources makes it imperative that skilled manpower should be used only on the tasks which no one else is trained to perform.
§ Mr. David Mudd (Falmouth and Camborne)
As the Minister knows, one of my great problems in Cornwall involves the provision of adequate lip-reading tutors. The report to which he refers will contain a proviso that when economic conditions allow the whole subject of 330 tutors for lip-reading will be sympathetically examined to ensure tighter coverage in the remoter areas of the country.
§ Mr. Morris
I am aware of the hon. Gentleman's deep personal interest in this matter. His point about lip-reading tuition is well taken. There will be extensive consultation on the findings of the report to which I referred. The hon. Gentleman's remarks will be fully taken into account.
With his sincere concern for deaf children, my hon. Friend will be aware that the Court Committee discussed in some detail services for the detection of handicap and for the provision of treatment and support to handicapped children generally and their parents. Its proposals included the establishment of district handicap teams who would be based on general hospital assessment units—which the committee proposed to rename child development centres. Such centres would, the committee proposed, have strong links with area audiology centres. We have been consulting widely on the committee's major proposals, including those for a district handicap team, and we shall, of course, take into account the points made by my hon. Friend. It will take some time to consider all the comments received, but we aim to make a statement as soon as possible.
I turn to the position in Nottinghamshire. The prevalence of profound, pre-lingual deafness in children generally is thought to be of the order of 1.5 per thousand live births. Less severe degrees of impairment occur more frequently, but no exact figures are available. Nottinghamshire has a total population approaching one million and in 1975 there were nearly 12,000 live births. Thus, the number of children born with a profound hearing loss can be expected to be of the order of 20 each year. The health authority has adopted a policy of total screening by suitably trained health visitors. A further test for hearing takes place between the ages of five and seven years. On diagnosis of a hearing loss the child is referred to a medical officer or general practitioner who, where appropriate, arranges for him or her to be seen by an ear, nose and throat consultant.
As I said earlier, there is often a difference between policy and performance, but I am advised that all the 331 health visitors who carry out screening tests in the county have now received specialist training and that it is proposed to hold training courses twice a year for new entrants to the service. These measures should make a significant contribution to bridging any gap that exists between precept and practice.
An important and developing function of the district general hospital is the provision of comprehensive assessment services for handicapped children of all ages up to 16 years and with all types of handicapping conditions. My Department gave guidance to authorities on the establishment of such centres in 1971, following advice from the Sheldon Committee, and in the Consultative Document on priorities we draw attention to the need to develop assessment services in areas where they are not at present available.
The aim of the sevice is to facilitate the multi-disciplinary assessment of the handicapped child and to reassess him or her at appropriate intervals in the light of the effect of treatment, education, training and environment, so that appropriate support can be given to the child and the family. Such facilities might form part of the service of the children's outpatient department and we have reminded authorities of the need to provide suitable accommodation for audiology.
I understand that the main comprehensive assessment service in Nottingham is based on the City Hospital and that it has the appropriate facilities and staff available for diagnosis and investigation of handicapped children. The regional health authority's strategic plan includes as one of its priorities the provision of paediatric assessment services in all areas in the region.
At present, following diognosis, children in Nottinghamshire can be referred to the hearing assessment centre based at Ewing School for the Deaf, which is in my hon. Friend's constituency, where a multi-disciplinary team meets two or three times a month. This unit is available to serve the whole of the county, although it is situated in the city itself, which is in the south of the county. I fully appreciate the travelling difficulties this can cause. I believe, however, that the relatively few children living in the north of the county travel to Sheffield.
332 Effective help for deaf people and their families demands close co-operation among health, education and social services. Only where a close working relationship exists among members of various disciplines will there be found the basis for a comprehensive service for deaf people of all ages.
Unfortunately, this need for multi-disciplinary co-operation is not always appreciated, with the result that there may be duplication of effort and an inefficient use of scarce resources. I do not doubt that those responsible for organising services in Nottinghamshire are aware that a combined approach is essential, but it is our experience generally that relatively little communication takes place between the medical and social services. This is greatly to be regretted, for it is of fundamental importance that the social implications of deafness should be recognised by those responsible for diagnosis and that a close relationship within the framework of a comprehensive assessment centre should be established by members of all the appropriate disciplines.
The ideal aim would be the establishment of a multi-disciplinary team in which medical, educational and social assessments all make a contribution to the overall decision regarding treatment, rehabilitation and educational placement.
It is evident from our inquiries that the health and personal social services in Nottinghamshire are very much concerned to bring about improvements in the local situation. Last year a report, which is at present confidential, was prepared by a working party set up by the community health councils in the county to look into hearing aid services. This, its first report, concerns services for children. I understand that, although no member of the area health authority or social services department was included among the members, there is a large measure of agreement and support by the health authority for its findings.
Some of the recommendations in the report have already been acted upon, notably those relating to the provision of hearing aids and earmoulds and I understand that, as a result, a considerable improvement in the situation has been achieved. I see the report as forming the basis for a continuing discussion between the area health authority, the 333 education authority, the community health council and social services. I understand that a further working party is now being set up to work out jointly the needs and priorities for hearing impairment generally, and I warmly support this approach.
The social services department also recently conducted a management review study on the needs of the deaf. The findings of this study are currently being discussed with the staff concerned. These reviews are generally indicative of a recognition that the needs of the deaf have for too long not received adequate attention or a fair share of resources.
The fact that the headquarters of the Institute of Hearing Research is located in the city of Nottingham will, I am sure, provide a source of encouragement to local services. Certainly, there can be little doubt that research carried out in Nottingham will have beneficial effects on all aspects of audiology.
I know that my hon. Friend takes some pride in the choice of Nottingham for the headquarters of this important new institute. I am glad that he referred so kindly, warmly and appreciatively to Dr. Mark Haggard as the director of this new institute.
Finally, I should like to say something about the ability of Nottinghamshire to improve the service 'provision generally. Although Nottinghamshire Area Health Authority (Teaching) will no doubt be keen to undertake any necessary improvements in its services for the hearing-impaired, my hon. Friend needs no reminding of the difficult financial situation that faces both Trent Regional Health Authority and the area health authority (teaching). As my hon. Friend the Minister of State for Health and Social Security explained to my hon. Friend on 25th May, when they discussed the health authorities' financial difficulties, at a time when some other Government and local authority services are being held to "nil growth", in spite of the economic difficulties facing the country, the Government have made it possible to sustain nationally a growth rate of about 1½ per cent. per annum in current expenditure in the National Health Service. Trent Region has been given nearly twice the national average this year—nearly 12 times the rate of 334 the least favoured region. This amounted to more than one-sixth of the total additional funds available. Nevertheless, a deputation from Trent RHA on 11th May left Ministers in no doubt of the financial problems facing the region in the next few years.
In parenthesis I should add that I understand that my hon. Friend the Minister of State for Health and Social Security will again be seeing my hon. Friend the Member for Nottingham, North on 5th July to discuss health services in the Trent Region.
Allocations to areas are, of course, a matter for the RHA. I know that Nottinghamshire AHA(T) has recently made representations to the RHA about the difficulties facing it in the next few years in commissioning and opening various capital developments currently under construction, including phase 1 of the new University Hospital, the new ward block at the City Hospital, and the adult mental handicap unit at Highbury Hospital. These difficulties are already well known to my hon. Friend, and I am confident that he will take them into account when pressing, as he has every right to do, for improvement of the services which we have been discussing in this short, but welcome debate tonight.