§ 6.31 p.m.
THE DUKE OF MONTROSEhad given Notice that he would ask His Majesty's Government whether they can make any statement regarding the present position of the Government aural aid, and its prospective distribution to the public. The noble Duke said: My Lords, I beg leave to ask the question standing in my name.
§ LORD WALKDENMy Lords, I am sure all who are deaf would wish to express their gratitude to the noble Duke for the persistence and vigour with which he has pressed this question on the notice of your Lordships' House. On three or four previous occasions the whole matter has been raised, and there is a great deal of public interest in it. Like the noble Duke, I have received a good many letters on the subject, and I should like to give the noble Duke as full an answer as I can to the important question which he has raised. He will remember that on previous occasions I did describe the general policy of the Government. I think I pointed out that the first: stage was to have an expert inquiry into the technical requirements of a hearing aid. This was undertaken by the Electro-Acoustics Committee of the Medical Research Council. Their work has been satisfactorily completed and we are very grateful to them for the great help they have given us. Production was arranged under the æ gis of the Government, in order to avoid commercial exploitation, which was complained of very much in respect of the aids supplied by different people. The third point was the problem of organizing the distribution of the hearing aid through the Health Service, on the advice of ear specialists. It must be done with the specialists' assistance, otherwise we should get astray with it. The other point was to provide for the supply of aids free of charge to patients when the National Health Service comes into operation.
The present position is that large-scale production of the hearing aid is in progress with the object of having it available 694 for distribution beginning on the appointed day under the National Health Service Act which it is contemplated will be July 5 next. I must admit to some disappointment, indeed, deep disappointment, that the date has had to be postponed to July. We had hoped at the beginning for January 1, then for March 1, but now we are compelled to look forward to July 5 as the date when the Act will come into operation. At an earlier stage it seemed possible that supplies might be available before the operation of the new Health Service, but it now seems less likely that the aid will be available in advance of the appointed day. The important consideration has been to ensure that the instruments supplied to patients would be as efficient and reliable as possible and that has caused some of the delay. If there is criticism of apparent delay it can be said that this is due to the process of production taking longer than was anticipated, and also to the desire to have proper regard to the efficiency of the aid.
Of the other queries raised by persons interested one has been, "Has the aid been independently tested, and does it compare well with other aids provided by independent firms?" The position here is that the aid is based on the research work of the Electro-Acoustics Committee of the Medical Research Council. The report of this Committee's research will be published very shortly and everyone cncerned will be able to read their findings and their survey.
§ LORD REAMay we have a sample of the instrument to test? The only way to reach satisfaction is by actual test. We were promised some time ago, I think by the noble Viscount, the Leader of the House, that we should have one of these instruments available for actual test and criticism before it was put into production.
§ LORD WALKDENI am glad the noble Lord has raised that point for it shows his keenness in the matter. I am able to say that the aid has been independently tested. The position here, as I have said, is that the aid is based on the research work of the Electro-Acoustics Committee of the Medical Research Council. On the basis of its research the Committee arrived at the requirements which an aid must satisfy, and for a final test four working models were constructed. These 695 were tested at hospital clinics in London and Manchester on twenty-seven persons suffering from various degrees of deafness and well practised in the use of hearing aids. The individual tests lasted about three hours; in each case comparison was made with the patient's own hearing aid and also with a highly-recommended American hearing aid. Twenty of the patients heard best with the new aid—our aid—and three others equally well. All commented on the exceptionally good reproduction of speech by the new aid and preferred it on that account. The whole twenty-seven gave satisfactory findings. After this testing, a manufacturing specification of this aid was produced with the help of the Post Office research engineers and I want to express appreciation of the assistance they have given us. They are interested, of course, in enabling telephone customers to listen effectively on their instruments. With their assistance specifications were produced, tenders were invited, and contracts placed by the Ministry of Supply.
I will now describe the arrangements for distribution and provision of aural clinics. The intention is that distribution shall be made through the Health Service on the prescription of fully-qualified ear specialists. It is of the first importance that distribution should be made under proper medical supervision not only to ensure the best use being made of the aid, but also to avoid disappointment to patients. I am sorry to say there are certain types of nerve defects, hopeless cases, which neither this nor any other aid yet devised can benefit. Skilled diagnosis is essential for the proper working of the scheme. This means that arrangements should be made at selected hospitals with proper facilities and specialist staff for the purpose, and that the arrangements should be an integral part of the hospital services to be administered on the Minister's behalf, by the newly-formed Regional Hospital Boards.
The Minister of Health will shortly be advising the Boards on the nature of the arrangements which will be necessary and asking them to determine where the clinics should be provided. Arrangements are also being made to train the necessary technical staff who will perform the elementary servicing of the aids at these clinics. The aids will be supplied free to patients for whom they are prescribed at 696 these clinics, and servicing will also be free, unless replacement or repair is made necessary by lack of care on the part of the people who have had the free aid. Until the Regional Hospital Boards have been able to make their plans it is not possible to say how many clinics will be provided. A limiting factor is the availability of the specialists, who are essential to the scheme. They are rather rare now, and they are not easy to find. In the first instance it may be necessary to begin with a comparatively restricted number of clinics and to build up on this foundation as quickly as posible. At the outset the object will be to provide clinics at least in the main hospital centres—for example, Birmingham, Manchester, Liverpool and Leeds. As to the supply of batteries, that is a very important point. The intention is that batteries required for the Government hearing aid will be supplied free, the same as the aids themselves. They will be available at the centres where the aid itself is supplied—
§ LORD WALKDENCertainly. As there is no charge for the aid there is no question of Purchase Tax. Purchase Tax will not come into it at all, nor will any other tax; it is absolutely free. That will apply, I may say, to ex-Service men and to any other people who need this aid. If, on being tested at a clinic, it is found that the aid will help them, they will be supplied with it free, and afterwards it will be serviced free for them as long as they live. The batteries will be available at the centres where the aid itself is supplied, and, to reduce inconvenience to patients, it is hoped to supply them also through other hospitals. These will be part of the arrangements to be made by the regional hospital hoards. In conclusion, I may say that we have had a certain amount of criticism from the hearing aid industry in regard to the Government's policy in this matter. The first criticism is aimed at the decision to produce a new hearing aid and not to use the existing products of the industry itself. This decision was deliberately taken in order to avoid the commercial exploitation which has been so often condemned in the past. I think the noble Duke, the 697 noble Viscount, Lord Cecil, and others, described that exploitation as being pretty shameful in many cases. The Government's object has been to produce a scientifically designed hearing aid which will give better results and will, at the same time, be produced at a cost less than the proprietary aids. A second line of criticism has been that the industry is not being used in the manufacture of the Government aid. The contracts placed were based on tenders which were open to a number of firms making proprietary hearing aids, but the Ministry of Supply have preferred the lower tender of other manufacturers, in an endeavour to get the aid produced in the public interest at the most reasonable cost. I may say that the Ministry is confident that, when the new service is in full operation, it will give great satisfaction and will be an untold blessing to thousands of persons who suffer from defective hearing.
§ LORD REAMay I say one word before my noble friend withdraws his Motion? We are all grateful to the noble Lord opposite for the much more satisfactory statement that he has made to-day. Obviously, as the noble Lord puts it, the hospitals must have preference in the case of those who get the aid free. But there are a large number of people who do not come into that category and who have to buy these extremely expensive and not very effective machines. Is there any hope that, within a reasonable space of time, these machines of Government manufacture, obviously of greater efficiency, will be put on the market, so that people who do not claim free aid from the hospitals will be relieved of the necessity of having to pay the outrageous prices which they are at present charged for instruments?
§ LORD WALKDENI think that the noble Lord misunderstands the position. There will be no need for anyone, rich or poor, to purchase these excessively expensive aids when this scheme comes into full operation. At the centres where the clinics are set up, the testing will take place and the aids will be provided to everybody and anybody who needs them—including even the noble Duke himself or any other noble Lord who needs one. I may need one myself one day and I know where I shall get it, without money and without having to consider the price.
THE DUKE OF MONTROSEI would like to ask the noble Lord, to whom the 698 aid will belong when it has been supplied. Is it still a Government aid or could the recipient consider it as his own property? Somebody might want to sell his aid. Would he be free to do so? Does it become his aid, or is it still a Government aid?
§ LORD WALKDENThat is rather an important question affecting the Chancellor of the Exchequer.
§ LORD WALKDENWe give people these aids to aid them in their distress. If they die, I should think that the return of the aids to the clinics would be asked for as a matter of honour and of Christian conduct. The clinic could ask for it on notice of the person's death. Probably by the time the poor fellow died the aid would have become ineffective and it would not be worth while to get it back. I do not think we need pursue that point.
THE DUKE OF MONTROSEIf an ex-Service man to-day is deaf and he can say that his deafness is attributable to active service, he can get a free aid from the Ministry of Pensions; but if he was a little deaf before the war and he was called up, then he can only say that his deafness has been aggravated by the war, and he cannot have a free aid from the Ministry of Pensions. The difficulty seems to be that the Ministry say: "We do not know how much is aggravation and how much was original and, therefore, we cannot decide to give you a free aid." That is very hard on the ex-Service man. As you are going to give a free aid, I do not see that it matters whether a man's deafness was attributable to or aggravated by the war. Will it be possible for the Government to get over that difficulty, for the sake of the ex-Service man?
§ LORD WALKDENI think I can assure the noble Duke that the painful argument about whether the trouble developed consequent upon military service or for some other reason will vanish. A man who is deaf, whether he has been in the Army, the Navy, or the Air Force, can go to the clinic and get an aid. Any question of what happened to him during his military, naval or Air Force service will not be raised. The question will simply be: "Are you deaf or are you not deaf?" or "Can we help you or cannot we help you?" The clinics will help him if they possibly can.
THE DUKE OF MONTROSEThen I understand that it does not matter whether the deafness is attributable to or aggravated by the war; he will still receive free aid.