§ THE DUKE OF MONTROSE had given Notice that he would ask whether His Majesty's Government can now give any information regarding the Medical Research Council's inquiry for the production of an improved and standardized aural aid; and what arrangements, if any, are visualized for its manufacture and distribution; and move for Papers.
§ The noble Duke said: My Lords, you might think that, in rising to move the Motion which stands in my name, I ought perhaps to apologize for bringing this same subject to your Lordships' attention so often. But if your Lordships could realize what an amount of correspondence I receive from poor people asking for advice about aural aids—where they can be got, what they cost, which is the best and so on—asking for help, in other words, to enable them to keep their employment, to enable them to keep their salaries, and by retaining their employment and their salaries to maintain their homes, I feel that your Lordships would recognize the urgency of this matter. Therefore you will net mind if I do not so much as apologize for troubling you so often on this matter. I think you may applaud my humble effort.
763§ This is what has happened. Early in 1944, the Government, through the Royal Medical Council, appointed a committee to make research into the provision of a really good aural aid which could be manufactured and sold at a reasonable price. Towards the autumn of 1944 I broached the matter for the first time in your Lordships' House, and asked what progress this committee had made in carrying out the work for which it was appointed. The Government spokesman of that day stated that it was then too early to give any definite information. So I waited until March, 1945, one year after the appointment of the committee—and then I again troubled your Lordships by asking what progress the committee had made. The Government spokesman again informed me that it was too early to give me any definite information, but that it was expected that in the autumn of 1945 the Government might be in a position to say something. So in December, 1945, I troubled your Lordships once more, and again asked for information as to the progress which the scientific committee were making. I was informed by the speaker for the Government, on that occasion, that they were again hoping to find perfection round the corner, but that I was still too soon with my inquiry. I am afraid I got rather angry, and I said I would come down here again in three months' time and demand a definite statement.
§ Well, I have been very patient. I have waited six months—that is until June—and now I come here and ask for the fourth time whether I can have some definite statement as to what this committee have done in carrying out their researches. Has it discovered a perfect aural aid? If so, is it really preparing and planning to manufacture and distribute it in the country? This is Derby Day, and I am really getting very tired of leading my old horse out on the course again. I am beginning to have doubts about my trainer. I would like to see the horse win, and then I would relegate it to the stud, hoping that it would produce some hopeful aural aids. But, seriously, I really would like to have some information, assuming that the committee have reached the stage when they have got a really good aural aid. There is a rumour to the effect that the Post Office are going to produce an aid. 764 I wonder if that is correct. If it is, I do not understand why the Post Office should have anything to do with the production of such an apparatus. But if there is to be a standard national aural aid, can I be told if it is going to be manufactured by the Government? Is this going to be an industry which the Government are going into, or will the Government put out the manufacture and production of the aids by contract to existing aural aid makers?
§ If the aid is to be made under contract by manufacturers of aural aids, I would ask and advise that there should be a test imposed. No aid, I suggest, should be sold unless it has passed a test and has been given a certificate from the Government that it is a good and efficient aid. There will be a new light industry if the manufacture of aural aids is taken up by the Government. And it is going to be a big thing. I wonder if the Government have considered the possibility of going into the export trade with aural aids as well. There is not merely a necessity for aural aids in this country, but a great need for them exists also in the self-governing parts of the British Commonwealth—Australia, Canada and Africa. I do not think aids are made in any of those countries. In Germany and France, I understand, there are not the means for making aids either, but there is a great demand for them. Therefore, when they are considering this question, the Government have the opportunity of encouraging and developing a great new light industry.
§
When the aids are manufactured, either by mass production or in any other way, the distribution of them will be a very important matter. The Minister of Health speaking in another place the other day said something which I would like to trouble your Lordships by quoting. He said:
It is an awful business that poor people afflicted by any degree of deafness should be the subject of exploitation. Some appalling prices are being demanded for these hearing aids, and, when our apparatus has been perfected, I propose to take steps to see that it is made available without any exploitation by private people in its sale.
Now that is very good as far as it goes. But when the Minister refers to "our apparatus," that leads me to assume that the Government have an aid. But how is it to be distributed? A source of trouble to-day is that we have in this country so many different kinds of aids each of which
765
has its own selling agency. The maintenance of these selling agencies, with their nice and beautifully-clothed young gentlemen behind the counters, costs money, and that helps to put up the prices of the aids to unreasonable limits. Therefore I suggest that concentration in the matter of distribution would be a very good thing. If distribution is to be a part of the new national Government service, I hope that it will be arranged for the distribution to be carried out through clinics established in all the large infirmaries or hospitals in the country. At these clinics there should be facilities for the examination of people with regard to their hearing. They would then be able to say that this or that aural aid would suit a certain person best, and that person would be able to get it from them at a reasonable figure. That is the best way to concentrate the distribution, through Government hospitals or clinics.
§ I would like to ask also at what price the aural aid will be sold. I said last time that aural aids were extremely highly priced, and the Minister of Health confirmed my statement when he said that they are exploited at £30 or £35. Since I raised the question in your Lordships' House two firms in this country have already reduced the price of their aids to £12; but the price might come down further. This ought to be part of the national medical service. The Government are going to supply in that Service, I understand, artificial teeth, free of cost. They are going to supply spectacles, I believe, free. If the Government are going to supply artificial teeth free and spectacles free, why should they not supply artificial ears free? If a man cannot bite, he is given free teeth. If he cannot see, he is given free spectacles. If he cannot hear, why not give him free ears? Why give free teeth and free spectacles to people, yet not free aural aids?
§ The other point to which I would draw your Lordships' attention is that aural aids must have electric batteries. Without them the aural aids are no use. It is estimated that the cost to a deaf man in maintaining electric batteries to keep his hearing aid in operation comes to about £6 a year. That is a big charge. Why should it be so high? The Government, in their national medical service, will give people suffering from diabetes continuous free treatment. Why, then, should a deaf man not be given free batteries to keep his aural aids in operation? I must congratulate the Government on the fact that 766 since our last debate on batteries the purchase tax has been removed. That was a great triumph, but the gilt must come off the gingerbread because I have already received notice from one firm of battery makers that die price of their batteries has been increased. In some cases the increase is as much as 50 per cent., so that the people who really benefit by the Government's consideration in taking off purchase tax are the manufacturers, and net the deaf people.
§ It might be a good thing if the Government consider the manufacture of batteries on a mass system. Batteries made in this country are very poor, compared with those made in America. Even the best British battery is very poor. I have some American batteries of pre-war manufacture which are still operating satisfactorily. One would be very lucky indeed to get a British battery to last one month, and that is why it costs an average of £6 or £7 a year for a person to maintain his aural aid. I would also ask, on that subject, why the Government cannot in the meantime facilitate the importation of American aural aids, or Darts of aural aids. If we could import freely some of the small valves and batteries used in America we could make up the machines in this country. It is very difficult now to get permission to import, and I suggest that the Government should allow, and should facilitate, the importation of American aids and parts of aids. I must say that I have a personal grumble there. I was given an aid as a present from the American Red Cross, as a mark of appreciation of the efforts we are making in this House. I accepted the present with thanks, but by the next post came a form from the Customs authorities demanding £6 IOS. revenue tax from me—on a present! If I had been a wounded soldier and had lost my arm, and some friend had given me the latest American artificial limb, I should have to pay £27 tax on it. Does it not seem ridiculous that we are charging tax when American dollar values come into this country free? It seems an extraordinary proceeding. Surely we should be grateful for such gifts and accept them without taxing them? Therefore I ask the Government to consider, also, the freer and facilitated importation of American aids and parts of aids.
767§ Before the new aid on which the Government are working can become a national standard aid a period of time is bound to elapse. I think I am right in saying that the national medical service will not operate before 1948. It will be 1950 before the full organization is in operation and it will be 1950 before these Government aids are available on a large scale. Are deaf people really expected to remain unable to get on with their work until 1950? That is a long time. Between now and then there is a vacuum to be filled, a gap to be bridged. Why should the Government not approve two or three of the best aids in this country—call them Mark I aids—and make them pass a Government test of efficiency? These aids might be distributed to the people at once, at a minimum cost. Later, when the Government have perfected their own aid and have their plans all ready, let us have the Mark II aid, the Government national standard aid. Let us do something now with Mark I, and go on to Mark II.
§ That is the main point. I can quite imagine that the noble Lord who replies will tell me that this will all cost money. I know it will. But doing something for the deaf is not merely a sort of charity; it is a very good investment. If we do nothing whatever for the deaf in this country, leaving them to struggle with their difficulties, they will be incapable of doing anything. They will have to be housed in institutions all over the country. That would cost a big sum. It has been estimated that it would cost this nation £7,000,000 to maintain in idleness all the deaf people in the country. If something is done for them, if they are put in institutes where they can learn lip-reading and finger-language, and given aural aids where possible, then these same people will be able to take up industries of all kinds. I have seen them engaged in book-binding, I have seen them in printing works, I have seen them engaged in carpentry, I have seen them in engineering, and I have seen them in horticulture. If they are working they will be earning good wages, and they will not merely be wage earners, but will maintain good homes. They will become good subjects, and instead of the whole burden of £7,000,000 a year being placed on the public Exchequer, there will be a lot of self-respecting men who can maintain 768 themselves and their homes. Therefore, this is not charity. It is a sound investment for the Government to undertake. I do hope that they will be able to report good progress. I beg to move for Papers.
§ 3.5 p.m.
§ VISCOUNT CECIL OF CHELWOODMy Lords, I really have very little to add to what has been so very admirably said, if I am not impertinent in saying so, by the noble Duke. I entirely agree with everything he has suggested, and I rise mainly to make one observation. The noble Duke spoke about import difficulties. There is no doubt that there are at present import difficulties. I have had experience of those difficulties myself. I went to view and try an American machine at the London office of the company. I tried it. It was not very cheap, but otherwise it seemed to be a very interesting machine. I arranged with the gentleman who showed it to me that he should send somebody down to my little house in the country where it could be fully tried. That was months ago. I have called at the office once or twice since. There is always the same reply. He is quite ready to do it, but he cannot get the thing over from America. It may not be the fault of the Government or the Treasury or the Customs administration, but it is the fact that this very valuable instrument, which, in some respects, is quite different from, and superior to, anything I have seen in this country, has not arrived here.
In the same way, I went to another place in order to get a new part for this very machine which I hold in my hand at this moment. I was told that they were bringing over a particular part, which was made in America, better than it could be made here, but it had not arrived. I said "Where is it?" They said: "It has really started." This was weeks ago. "It is on the seas and it will be here directly." I have seen and heard nothing of it. I cannot help thinking that there must be some great hedge erected somewhere which prevents the full and free importation of these things from the country where they can be made best. I hope that the Government will look into this question very carefully, because it is really a great scandal if there is some red-tape rule which prevents the full freedom of importation of these things which are really deeply necessary for a very deserving section of the population of this 769 country. Probably the noble Lord cannot give me an answer immediately, but I hope that he will see that his colleague who is responsible does not put the report of this debate into the waste-paper basket, but makes some investigation with regard to the matter.
With reference to other matters that have been raised, I am a little nervous about the question of distribution. I shall be very interested to hear what my noble friend has to say. I agree to a very large extent with what the noble Duke has said, but I do not feel that clinics established in various towns in this country would be a very effective method of distributing those instruments to the poorer classes. Obviously, if those people lived in the country, as many of them do, they would not be able to get to such places without great difficulty. I hope that something better than that will be achieved in the way of distribution, but I wait to hear.
There is one other matter which I will mention. The Minister of Health—I am sorry I have not got his actual words here—said something to the effect that they hoped in the future that there will be the same care taken with regard to the hearing of the population as is now being taken with regard to their eyesight. I hope that meant—I am not sure that the words quite cover it—that there would be the same kind of inspections in the schools of the country in respect of defects of hearing as are now made in respect of defects eyesight. In quite a number of cases there is no doubt that if you can deal with a defect in hearing at the very outset, and apply proper remedies, you can at any rate check it, and make hearing much more effective. I hope that it will be made quite clear that it is part of the policy of the Government to see that everything that can be done for the children in the schools will be done.
I am told that a new machine—the outcome of the work of this Committee—has already been made. I do not know whether that is so. Probably if it is so, it has been made only in such small numbers that it is not possible to put it on the market for general sale. If that is so, I hope that everything that can be done will be done. I should like to ask some questions about the new machine, but I am not sure that my noble friend, for all his attainments, would feel that he is 770 sufficiently expert to deal with those matters. I do, however, want to say one thing about it. I speak in the presence of the noble Duke, who knows far more about this matter than I do. I do not think any very great advance has been made essentially in these hearing aids for some time.
Since the original device of having an electrical magnification of sound which is practically the central part of all these machines, there has been no great advance. The best machines I have been able to try are still very defective, and they are defective for the reason that while they convey the vowel sounds they do not convey the consonant sounds. The consonant sounds, of course, are much more delicate and much less robust than the vowel sounds. They have first to go through the diaphragm of the receiver and then the diaphragm of the loudspeaker, and they get lost altogether. They are not conveyed at all. I hope that a very complete study of that particular difficulty has been made. I do not know whether my noble friend is able to say anything about it, but to my mind it is by far the most important of the difficulties in the way.
There is also one other difficulty which seems to me not to be overcome at all, and that is to find a machine which will do whit a normal ear can do, but which no machine can do, namely, make a distinction between the sounds to which you want to listen and the sounds to which you do not want to listen That is a very delicate matter. Of coarse, when sitting at the dinner table, with an ordinary good healthy ear, it is possible to listen to the person at the other end of the table, and ignore all the intervening speakers. Very often that is a good plan. But no machine can do that unless there is some special device for it. I do not know whether anything has been done to meet that difficulty. But, unless something is done, you cannot hear the speech to which you wish to listen.
These are just casual observations which I hope my noble friend will consider. I particularly with to endorse with all my strength the plea of the noble Duke, that this is really a very urgent matter which is affecting the livelihood and happiness of a great number of people, and that, even if we cannot immediately get a perfect machine, as I do not suppose we shall, nevertheless some 771 decent machine would be of enormous value to the poorer classes of the people of this country.
§ 3.9 p.m.
§ LORD WALKDENMy Lords, I feel grateful to the noble Duke and his colleague for raising this matter here to-day. I esteem it a great privilege to have been deputed to reply. The noble Duke has certainly chosen a fortunate day, one on which I can make some positive statements in reply to his numerous questions. I am afraid, however, that I cannot do that with regard to all his questions, because some of them went beyond the Motion on the Order Paper. Neither, I am afraid, can I enter into the inner technicalities of hearing aids, old and new. I am not a technician, and one must leave that to those who are acquainted with all the details. But I can, I hope, make a statement that will be deemed satisfactory, at any rate to be going on with, from now onwards, and which will be welcomed by all who are suffering from deafness.
The Medical Research Council, who were entrusted with the inquiry, and their three sub-committees, have completed their researches and have submitted the results to my right honourable friend the Minister of Health. All that work is therefore finished. The Minister has given a great deal of personal attention to the whole matter, even in the midst of all his other vast responsibilities, which are, as your Lordships know, very heavy, and he has authorized me to say that, with the approval of the Government, complete and generous lines of policy have been decided upon, quite definitely.
Firstly, the Electric Acoustics Sub-Committee evolved a hearing aid which has been tested and found to be as efficient as any now available, either British or American. We cannot find anything better, and we think ours is an improvement on anything that has existed before. This new aid will be supplied free of charge (there is no question of paying £8, £10 £12 £25, or the £62 which was mentioned on a previous occasion, for one of these aids) to all who need it, when the National Health Service comes into operation. The Bill for that service was introduced last March—I do not think the present Government lost much time over it—and it is now winning its way 772 through Committee in another place. It will appear in your Lordships' House before very long, I hope, and then we shall see from what date it is likely to come into operation. I cannot speak firmly at this moment as to the date when it will be an Act, but I am informed that it is expected to come into full operation in 1948. That may appear to be at a somewhat distant date.
There may be eighteen months or perhaps a little more as an interim period, and during that time the Government will do their best to make interim arrangements for the supply of the new aids, but of course they will have no authority to provide them free of charge until the Act is passed. They will have to do the best they can to supply it at cost price to patients through the hospital services. Of course, they have not control of the hospitals at present, but I am perfectly sure that all the hospitals will be only too glad to co-operate in making this aid available for those who need it. That is quite possible. There will also be provided facilities for servicing the maintenance of the aid (this is very important) with new batteries or other requirements or repairs, free of any charge except where the machine has been damaged by carelessness on the patient's own part. If he lets the machine get smashed or spoilt, he will have to pay for its repair or renewal.
Clinical arrangements will also be established, chiefly in the hospitals, though there will probably be others, by which any person may consult a fully-qualified specialist and have his hearing tested. In any case where deafness is likely to prove amenable to treatment, it will be accorded free of charge. If an aid is needed, it will be provided free of charge. One of the principal aims of the service will be the prevention of permanent deafness. The most careful diagnosis of its causes will be pursued and appropriate treatment given wherever it appears that hearing can be improved by medicine or by surgery. The Electric Acoustics Committee have also made recommendations for the provision of improved equipment for testing the degree of deafness from which any patient may be suffering. This equipment will also be supplied to clinics without charge.
The Ministry of Health is now very actively engaged on the immediate 773 problem of getting supplies of the testing apparatus, and the new aural aid produced. It is just a problem of production. They must be available in adequate quantities by the time the new National Health Service Act can be brought into force. If we can get them before, we will, and I am informed that the charge is not likely to be more than £10 for a very good aid. The help of the Ministry of Supply is being obtained, and we have every confidence in its ability to meet all our requirements. It did some wonderful work throughout the war in producing very fine and delicate instruments for the Forces and for other requirements, and it has assembled a splendid team of people with whom this work will be placed, and we are quite confident that the instruments will be made available at the earliest possible date.
Certainly we are not going to hand the fruits of these researches over to a market where anyone can produce them and do what he likes by way of exploitation. The noble Duke on the last occasion—and I have read his speech once more this morning—made a very drastic remark on that point. He said:
Surely the Government are not going to leave it to an unholy scramble to take what results from the work of the Committee and ensure its supply.We are not. We are not going to throw this invention over for exploitation by any people. It will be a State production, a State monopoly. The maximum benefit will thereby accrue to anyone who needs it and the State will only have to pay the cost price of production. These arrangements will bring to an end all the fraud and the profiteering of the past which have been so eloquently condemned in previous debates both by the noble Duke and the noble Viscount, Lord Cecil. They will inaugurate a new and brighter period for the deaf. The sufferings they have endured will be modified immeasurably. All the contumely, the cold-shouldering and the ignoring which they have suffered will be brought to an end. They will be able to obtain an aid that will help them to take their proper place in social and industrial life.The young people will also be dealt with most carefully from their youth up. They will be tested in the schools for every possible ailment—in their eyes, ears, nose or throat—and they will have free treatment. It seems strange that deafness was 774 not mentioned in either of the two White Papers, the great Beveridge Report or the Health Report issued by Mr. Willink for the Coalition Government, or even in the new White Paper issued by the present Government. It seems to have been overlooked, possibly because many people did not know what we could do for deaf persons. The researches have been made by very fine people, and now we do know what we can do, and every arrangement will be made to carry their recommendations into effect.
§ 3.19 p.m.
LORD SALTOUNMy Lords, it is with singular pleasure that I have heard this afternoon the noble Duke trying to induce a Socialist Government to undertake a new national industry. As an old. Tory I have not any special predilection on forms of trade so long as they are efficient, and if the Government system is proved superior to the "unholy scramble," nobody will welcome it more than I. But there is one thing every member of this House would wish to do, and that is to congratulate the noble Duke on the result of his persistent efforts, for I am sure that His Majesty's Government, although in charge of this matter, will be perfectly ready to acknowledge that it is his persistence and steadfastness that has brought this into being. I am sure we would all wish to congratulate him on the results obtained, and to wish the Government good luck in what they are going to do for the deaf, one of whom I may be soon myself.
§ 3.21 p.m.
§ LORD WOOLTONMy Lords, I should like to intervene for one moment, firstly, to say how glad I am to hear from the noble Lord that steps are going to be taken in the schools to look after the school children. If by that means we can prevent people from becoming deaf, it will be of even greater benefit than providing instruments for them when they are deaf. I hope that that work will be pursued. I know that medical officers of schools have a great deal do, but I am sure it will have very valuable results. There was one point in the noble Lord's reply on which I was not quite clear. He said the Government was going to have a monopoly of the production of these instruments. I take it that he meant precisely what he said, namely, that the. Government was going to have a monopoly 775 of the production only of these particular instruments they are now adopting, and that it did not mean that nobody else would be able to produce instruments, because there may in course of time be new instruments invented which will be even better than those produced by His Majesty's Government. I should like to be assured that the monopoly is not going to prevent new development.
§ LORD WALKDENMy Lords, I can assure the noble Lord at once that there is no intention to seek to monopolize the production of all these instruments. We shall, however, have a monopoly in respect of the production and distribution of our own creation, and I think everyone will agree that that is quite proper.
§ 3.22 p.m.
THE DUKE OF MONTROSEMy Lords, speaking with a knowledge of people afflicted by deafness, I am sure I can say they will be extremely grateful to the noble Lord for his very informative reply. There is no doubt that my old horse is not only on the course but can now see the winning post. It is very good to know that research has finished and that work will begin on making these aids. In connexion with schools, I hope the noble Lord will keep in mind the question of the supply of cinemas. We have developed in the past two great teaching agencies—finger-language and lip-reading. Those are the only ways in which you can make a deaf person understand language. With language comes intelligence, and that is the only way of lifting the deaf people from the state of the animal. If you bring in cinemas, you will have a wonderful means of educating the school-children, at a most impressionable age, with finger-language and lip-language, assisting the teaching with words, and the words with stories. I hope that in dealing with the education of the deaf in schools the Government will bear in mind the supply of cinemas and possibly the provision of a cinema theatre in each large school for the deaf. In view of the satisfactory answer, I ask permission to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.