HC Deb 02 December 1998 vol 321 cc847-54 12.58 pm
Dr. Jenny Tonge (Richmond Park)

Many people in the House may know that I am totally deaf in one ear. I make no secret of that; I have always found it quite useful to be able to turn a deaf ear to three teenage children and their music at 2 o'clock in the morning; to aircraft noise, which plagues my constituency; and—dare I say U?—to the House of Commons, on occasion.

I also share a few of the problems faced by people who are deaf in both ears, and they are getting worse. Three out of 10 people aged over 55 have this problem. Ten years ago, the Medical Research Council institute of hearing research revealed that there are 8.7 million deaf and hard of hearing people in the United Kingdom. Given our aging population, that figure is probably much higher now. The MRC reckoned that 5 million of those deaf people would benefit from a hearing aid, yet two thirds of them have never tried one.

Every Member of Parliament represents an average of 4,500 constituents who are missing out because they cannot hear very well. They are missing out on enjoying and making the most of life. Hearing problems can affect work, family and social life. They reduce confidence and create stress. People may struggle on with their lives, but they become increasingly isolated.

In a recent report, the Royal National Institute for Deaf People gave several examples, one of whom was a 58-year-old man, Maurice Strong, who lives in my borough. Before he had a hearing aid, he went out of his way to avoid conversations, but now he will talk to any one. He highlighted how hearing loss affected his marriage. When chatting with his wife, he found it increasingly hard to hear what she was saying. We all have that problem. He said: I was forever getting the wrong end of the stick which she thought was deliberate. Sometimes it may be, but in his case it was not. I'd accuse her of mumbling and we'd end up arguing. That would ruin their weekend. He also faced stress in the workplace. As a security operator, he was worried that he would not hear sounds. He said I got so tired trying to compensate for my hearing problems. I'd come home in the evening, have my dinner and just fall asleep. That is also a common problem, whether people are deaf or not, but the deaf suffer more stress during the day than the rest of us.

There is no need for these problems to occur. The RNID is having a publicity campaign to highlight the seriousness of deafness. For a start, we must take hearing tests as seriously as eye tests. A MORI poll carried out for the RNID revealed that only 22 per cent. of people over 55 have had a hearing test in the past 10 years, whereas 87 per cent. have had their eyes tested. That is in spite of the fact that almost half the over-55s have a hearing loss. Like sight defects, hearing problems often herald a more serious disease.

People do not get their hearing tested as a matter of course as they get older, as they do their eyes. We must overcome that fundamental problem. Wearing a hearing aid should be as acceptable as wearing glasses. Perhaps we should also stop making fun of people who are deaf. It is easy to do that: it is the Cinderella of afflictions. People with many other afflictions receive sympathy, but the deaf are laughed at, so we must try to change public attitudes.

If change is to occur, it must start with what is said—or often not said—in general practitioner surgeries. A significant number of people who consult their GP about a hearing problem are not referred for a hearing assessment. When I was a GP, I may not have heard what my patients said, and should perhaps have been referred at the same time. If people are not referred for a hearing assessment, they do not get a hearing aid. GPs play a crucial role in finding the one in five adult patients who are hard of hearing.

In the past year, the RNID has taken steps actively to support and inform GPs in carrying out this task. In June, it mailed 39,000 GPs in England, Scotland, Wales and Northern Ireland to give them warning of the possible increase in the number of patients requesting a hearing test. GPs were sent leaflets explaining the campaign to get them to ask all patients over 60 whether they are experiencing problems with their hearing. The aim is to persuade GPs to introduce the topic, and to refer patients for hearing assessments sooner rather than later. That is plain common sense, because the sooner people get a hearing aid, the more likely they are to get the best out of it.

GPs were also given a guide—a scratch pad—so that they would know what questions to ask if they were unclear. So far, more than 2,000 GPs have requested further information. That shows the widespread support for the campaign among GPs, and the lack of advice and information that they have so far been given by the national health service.

There is a limit to what the RNID can do. Indeed, the charity has already achieved more than the Department of Health. The Department must ensure that changes occur in audiological services. At present, the quality of service in an area is too dependent on the resources and priority that a local NHS trust gives to audiology. Waiting times, staffing levels, the range of aids available and the standard and quality of follow-up and rehabilitation are too variable and inconsistent. As in other areas of the NHS, it is diagnosis and treatment by postcode.

The time a patient has to wait for a hearing test varies. In some places there are hardly any waiting lists, whereas in others people may wait months. In London, people wait 15 weeks on average for a hearing test at the Central Middlesex hospital, but only 14 days at the Edgware and Hillingdon hospitals and the West Middlesex university hospital. Across the United Kingdom, the minimum wait for a hearing test is three days, and the maximum wait is a staggering 78 weeks.

It must be stressed that obtaining a hearing test is only the first hurdle that people must overcome. People are frequently embarrassed about their hearing loss, and more often than not they deny that there is a problem. The last thing they need is a lengthy wait to obtain a hearing test. There are too many psychological barriers to obtaining a test, without the NHS creating even more.

We construct barriers—in some cases, at every stage of the process of obtaining a hearing aid. Even after the long wait, many patients face a further long wait to obtain the appliance. In some places, the waiting time for a hearing aid is only a month or so; in others, the wait may be almost a year. In London, waiting times vary from a same-day service at the Royal London hospital—why it can achieve that and no other hospital can, I do not know—to a 364-day wait in other hospitals. A further difficulty may face patients. Following a hearing test, they may be offered only one hearing aid when they need two. Hearing aids are rationed.

The level of undetected hearing loss is immense, and in many areas there are serious problems with NHS audiology services. In considering those two basic facts, surely we cannot escape the conclusion that some initiative is required from the Government. I would welcome an announcement from the Minister that the NHS will rise to the challenge of working hard to reduce the number of people who are not benefiting from hearing aids. That figure is 3 million, and nothing helps concentrate the mind more than the setting of a target. I agree with the RNID that we should aim to reduce the figure to 2 million in the next five years. That is a modest target. What is the Minister's view? Will he consider a target being set by his Department?

It is reasonable that, once people have been referred by their GP, they should not have to wait more than a month for a hearing test or more than two months for their NHS hearing aid. A further target which should be considered by the NHS is the provision of a greater range of hearing aids. Digital technology is developing rapidly, but digital aids are rarely available on the NHS. In other areas of medicine and surgery, modern technology has almost taken over from the surgeons and physicians. How long will it be before national health service patients benefit from the new technology of digital hearing aids?

I look to the Minister to recognise publicly the serious problem that is faced by people who are deaf. It is no exaggeration to say that deafness can wreck marriages, stall careers and make people socially isolated. It needs to be remembered that, although the problems that are caused by unrecognised deafness can be immense, the average cost of fitting the present NHS hearing aid is only £90. Few NHS treatments come as cheap as that.

I understand that there are ever-increasing demands on the NHS—indeed, that is why my party consistently asks for a debate on national priorities in the NHS—but quality rather than the length of someone's life is the most important factor; quality of life is what we should look at. Increasing deafness destroys quality of life. I beg the Minister to improve our services for those.

1.11 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)

I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing time for this important debate and on her constructive and thoughtful comments. She is right to point out that hearing impairment is the second most common disability, next to mobility problems, in the United Kingdom, and that it is estimated that there are 8.7 million deaf or hard-of-hearing people in the UK. That means one person in seven has a hearing impairment. As she was right to stress, hearing impairment is not a feature just of old age. In the UK, 1,000 children are newly diagnosed annually as having a permanent hearing impairment.

Audiology services are, in some ways, a unique part of the NHS—they span all ages from children to older people; they support patients through diagnostic tests, rehabilitative care, and treatment through equipment, rather than medication; and staff often maintain links with patients throughout their lives. Audiology services provide a continuing health care service.

Like all services, audiology services should not stand still. Having recently started some work on hearing aid services, we are aware that some aspects of audiology services are not managed as well as perhaps they should be. To explore that, we established a working group to take a closer look at hearing aid services. The group's initial findings show that we need to take a broader look at audiology services, particularly their role in the community and the part that they play in a modernised NHS.

Our commitment to the new NHS includes fair access to consistently high-quality, prompt and accessible services throughout the country. That applies to audiology services in exactly the same way it does to other NHS services, but it is important that the NHS does not do that in isolation from other services. Partnership is the key to developments where services, such as those for hearing-impaired people, are provided by health departments, social services and, for children, education departments.

As the hon. Member for Richmond Park will be aware, the Government are committed to developing a new agenda, encouraging closer co-operation between social services and the NHS. It is one way in which we will be able to develop a much more effective service for patients and service users.

On social care provision, in September 1997, the social services inspectorate published a report entitled "A Service On The Edge". I do not know whether the hon. Lady has read the report, but its findings were not encouraging. The needs of deaf and hard-of-hearing people were often not properly assessed, consultation with users was spasmodic, and senior managers and councillors sometimes gave insufficient emphasis to that aspect of services. In some areas, the links between audiology units in hospitals and social services were not well developed.

Although that picture was depressing, the Department of Health was also made aware that there were examples of good practice in some parts of the country. As a follow-up to the inspector's report, the Department has decided to produce material to help social services departments and others to improve their services to that user group.

It is vital that NHS audiology services do not work in isolation from other parts of the community. To underline our commitment to partnerships between health and social services, in September we issued a joint publication, entitled "National Priorities Guidance", to both health and social services authorities. Links between audiology departments and social services departments, such as "one-stop shops", and making patients aware of the benefits of environmental aids such as loop systems can help to make such partnerships work to the benefit of patients.

In the NHS, patients are likely to encounter staff in audiology services who have a broad range of audiological skills. There are audiological physicians who diagnose, investigate and treat patients; audiological scientists who investigate and diagnose hearing impairment; hearing therapists who assess and provide rehabilitative needs; and audiology technicians who assess, fit and advise on hearing aids. A wide variety of expertise contributes to a quality service.

I know, too, that the audiology professions are working together to look at different ways in which to develop common career pathways. That is important because it will help to enhance opportunities for education and development for audiologists, and career development for those wanting to pursue a career in audiology.

The hon. Lady referred to the RNID's awareness campaign. She may also be aware that, in June, the Secretary of State for Health helped to launch the RNID's campaign to encourage people to seek the advice of their GP as soon as they become aware of problems with their hearing.

To help with that campaign, the RNID, as the hon. Lady said, wrote to nearly 40,000 GPs about hearing loss, and it followed that up in the autumn with a campaign to persuade people who were experiencing hearing loss to speak to their GP. I was pleased that the campaign was supported in some parts of the country by local audiology services.

I have already mentioned one way in which audiology services differ from others in the NHS—patients' needs are met through fitting a hearing aid, rather than medication. Nor do people need hearing aids for a short period. More often than not, once a hearing aid has been fitted, people will need it for the rest of their lives.

NHS Supplies provides 550,000-plus hearing aids per annum for use in the NHS, at a cost of approximately £16 million. There are more than 20 products within that range; they cover a wide range of hearing impairment, from mild to profound loss. They cater for the paediatric market, too.

The hon. Lady referred to the advances of technology. She is right to say that, recently, there have been great strides in developing hearing aids in both the NHS and the independent sector. In particular, digital hearing aids are available from the commercial sector. There are requests—she made the request again today—for those to be available from the NHS, too.

As with other forms of digital technology, we need to evaluate those new technological advances, in terms of both cost and clinical effectiveness, for the many people who need hearing aids from the NHS. At present, those aids are very expensive.

Evaluation and examination of the specifications of the aids, and determination of the practical problems as well as trials are required to find out what software and hardware developments are still required for those new aids to hold any advantage over existing advanced programmable analogue aids for a large number of users. Obviously, certain individuals have found them useful, but we are talking about widespread benefit and a wide range of impairments.

The NHS does not just supply hearing aids; it also offers support to deaf and hard-of-hearing people by providing rehabilitation services—an important part of the overall treatment—hearing therapy to support them in using their hearing aids and treatment for any associated problems.

Through advances in hearing aid technology, the NHS has helped to initiate a much broader approach to hearing solutions. For some time, NHS hearing aids have had an adaptation that enables deaf people to use loop systems.

Other developments are in train that will help to enhance services for children, adults of working age and older people. The results of those initiatives will help to pave the way for modern audiology services.

Children's services provide an important component of audiology services because children grow and their needs may change quickly—they will often return to have their hearing reassessed and hearing aids modified. Also, temporary hearing loss due to glue ear is the most prevalent audiological condition in children, requiring treatment that can be in the form of myringotomy, with or without grommets, and hearing aids. The Medical Research Council is conducting a trial of alternative regimes in glue ear treatment, which is expected to finish towards the end of 2000.

For many years, children have routinely been screened for hearing problems by health visitors, at around seven to eight months, using a distraction test, as the hon. Lady knows. In 1997, a review commissioned by the health technology assessment programme of the role of neonatal hearing screening suggested that the national screening committee should consider whether there should be a national screening programme for congenital hearing impairment. The review suggested considering a system of universal neonatal screening, followed at seven months by targeted screening using an infant distraction test. Through its sub-committee on child health screening, the committee is considering those suggestions for implementation across the NHS.

Any proposed changes to screening arrangements must be considered carefully to find whether they are feasible, and clinically and cost effective. The impact of any changes on children with hearing impairment, and on associated professional groups such as health visitors, also needs to be carefully assessed. We do not expect the committee to make rushed decisions on those important issues.

The health technology assessment reinforced the point, with which we whole-heartedly agree, that treatment should be initiated early and provided within a seamless service from health and education services. Links between health and education are crucial. We have consistently emphasised the importance of partnership working across services. For children, it is important that speech and language therapy, as well as audiological care, are provided, and that we do not overlook the important links with their education and longer-term needs.

On services for adults, we have recently funded another health technology assessment review covering the acceptability, benefit and costs of early screening for hearing disability. The Medical Research Council institute of hearing research will examine the role of early screening for people aged between 55 and 74 to find a cost-effective screening method for the ability to benefit from early hearing aid fitting. Many adults' hearing starts to deteriorate as they get older, and the project aims to consider the benefits of earlier interventions for people with hearing problems.

Hearing loss for older people is often regarded as a normal part of aging, so older people may not be getting the services that they need. Such loss is often accompanied by sight problems. Promoting independence is one of our key priorities in the "National Priorities Guidance". This priority stresses that the partnership of timely health and social services in the community can make a crucial difference to the ability of older people to maintain or achieve independence and a healthy life style. In addition, we announced last month that the next national service framework would be on services for older people. We are still considering the arrangements for taking forward work on that framework, but I would be surprised if it did not include hearing impairment for older people.

Although hearing loss is common in older people, it should not prevent them from seeking advice from their general practitioners. In 1994, my Department issued guidance, again based on research evidence, to the effect that there were clear benefits when GPs refer patients directly to audiology services, rather than first to an ear, nose and throat consultant.

More generally on disability, the Government set up the disability rights task force in December 1997 to consider how best to secure comprehensive, enforceable civil rights for disabled people within the context of our wider society, and to make recommendations on the role and functions of a disability rights commission. We announced in the Queen's Speech that we will legislate to create such a commission.

There is another important role for audiology departments in helping to raise awareness of hearing impairment. Earlier this year, the Government announced the timetable for implementing the provisions of the Disability Discrimination Act 1995. From October 1999, service providers will have to take reasonable steps to change practices, policies or procedures that make it impossible or unreasonably difficult for disabled people to use a service. They will need to provide auxiliary aids or services that would enable disabled people to use a service and overcome physical barriers by providing a service by a reasonable alternative method. From 2004, service providers will have to take reasonable steps to remove, alter or provide reasonable means of avoiding physical features that make it impossible or unreasonably difficult for disabled people to use a service.

We wrote to the NHS earlier this year about section 21 of the Disability Discrimination Act and announced that we would develop an action programme to support its implementation across the NHS. Without prejudging the results of the work, it is becoming apparent that one of the key responses for service providers must be to raise staff awareness of disability. However, the NHS will have some important resources to help it tackle that challenging agenda. By that I mean the expertise that staff in NHS trusts have developed over many years. Staff in audiology departments are a perfect example of my point—throughout the day, they are already helping people who are deaf or hard of hearing, and they can help to raise awareness of hearing impairment among other staff in their hospitals and in the wider health community.

As part of the need to raise awareness of hearing impairment issues, the NHS executive recently commissioned a video from a group of deaf film makers to highlight problems encountered by deaf people using hospital and GP services. The video will draw on the personal experiences of a number of deaf people, and will include their reactions to people speaking about them or shouting at them, and the difficulties that some health service practitioners have in understanding them. We expect that it will be used as a training aid for NHS staff who may encounter patients who are deaf or hard of hearing, or colleagues who may be doubly disabled in their day-to-day work.

The NHS executive has also been developing a good practice guide entitled "Doubly Disabled: equality for disabled people in the new NHS". It is aimed primarily at NHS managers and will consider disability in the NHS and the steps that managers might take to provide a more equitable service for disabled people. Voluntary organisations have contributed to the guide, which has already been shared with a wide range of people from all walks of life.

I am grateful to the hon. Lady for giving us an opportunity to discuss these important issues. I assure her that we are absolutely committed to ensuring that people who need audiology services from the NHS get a first-class service. Nothing else will do.