The Partially Deaf

HL Deb 23 March 1983 vol 440 cc1148-78

6.16 p.m.

Lord Harvington rose to call attention to the plight of the partially deaf; and to move for Papers.

The noble Lord said: My Lords, I beg to move the Motion standing in my name, and say at the beginning that I feel like Antonio in the Merchant of Venice when I say, "Alas, I am the unhappy cause of all this quarrel". I have been making some inquiries into how noble Lords have dealt with the matter which I propose to raise this evening, and I find that for some time now the noble Lord who has raised it has always prefaced his remarks with the desire to declare an interest; namely, that he was affected by hardness of hearing himself.

I am afraid that I am no exception to this rule. I have to ask for the same favour from your Lordships as other noble Lords have done in the past. In fact, if it were possible for 25 per cent. of this House to raise this matter they would all have to ask for the same indulgence. I made some statistical inquiries into what the probable deafness, to some degree, of this noble House is, and I find that it is verging on 30 per cent., which is perhaps more than your Lordships had realised.

After the 1981 International Year of Disabled People we moved, in 1982, to our own Government's Information Technology Year, and now, in 1983, we see the early days of the United Nations' International Year of World Communications; wonderful opportunities to focus attention upon the invisible handicap of deafness, which, in all its degrees and conditions, means a fundamental breakdown in human communication.

The Medical Research Council Institute of Hearing Research has reported that preliminary results of a national study show that some 10 million people in the United Kingdom have a significant hearing defect. Moreover, one in ten of those examined who believed their hearing to be perfect had a disorder that amounted to some degree of disability. This study, showing, as it does, that one in five suffers from hearing loss to greater or lesser extent, presents a challenge to us to try to overcome some of the problems.

I do not, however, in the limited time at my disposal this evening intend to raise issues concerning the difficulties of the education of children, nor areas relating to care and provision for profoundly deaf people, tremendously important though they are. Much valuable and dedicated work is being undertaken by the professionals in a wide variety of disciplines. The devoted and effective work which has been done by the right honourable gentleman, the Member for Stoke-on-Trent South, Mr. Jack Ashley, is a shining example to us all.

By far the greatest number of people with hearing loss are middle-aged or elderly, and I suggest to this noble House that not enough is being done to help them. Certainly hearing aids are provided free of charge under the National Health Service, if you can get them; but you have to wait a long time. However, there is a widely mistaken impression that all conditions and degrees of hearing loss can be remedied solely by hearing aids. But a hearing aid does not give back normal hearing; it is not a hearing restorer. For very many people, wearing a hearing aid is like spending one's life communicating on a very had telephone line. When he speaks in the debate my noble friend Lord Balfour of Inchrye will, I think, deal with some technical aspects of hearing aids, and we shall be interested to hear from him.

There is much encouragement in the developments undertaken by both the BBC and the IBA to provide sub-titled television programmes for deaf people. How often do we stop to think that sub-titles on TV are as important to deaf people as is radio to those who are blind? The sub-titles can be provided as an extension of the TV Teletext systems, but the cost of the Teletext sub-titling component is over and above that of the regular television set itself, and therefore it is out of reach of the vast majority of the people who have need for it. The Royal National Institute for the Deaf has established a Television for the Deaf Fund, to provide this kind of set for people who have other handicaps besides being deaf, but, unhappily, the fund attracts very little attention or public support.

I was much struck by a report in The Times on 5th January about Government provision of an extra £6 million to be spent over three years, to boost mental health care for the elderly. The report added that about half a million elderly people suffer from dementia. In this connection it is important to bear in mind some of the effects of hearing impairment on the lives of old people. They amount to a form of sensory deprivation and lead to social isolation. Social isolation is, in turn, associated with a number of other unmet needs in older people, and I am advised that sometimes the sensory deprivation is of such a severe degree that the person's mental state becomes impaired; for example, the acute confusional state known as dementia.

What now needs to be done to improve the hearing ability of older people? There is the problem of early ascertainment of disease in the elderly, and this is most important. This is a general problem, and in the case of deafness it is known that over half of the elderly have never had their hearing tested, and very many of them have no hearing aids. No doubt screening programmes in the elderly population must rest primarily with medical care and depend on the work of not only general practitioners but also health visitors and other community workers. This situation would call for further developments to the audio-logical centres. Perhaps the noble Lord, Lord Winstanley, will say something on this aspect of our problem.

The Royal National Institute for the Deaf is actively considering a number of these issues, but there is a limit to what a voluntary organisation can do. Ideally many more forces—statutory and voluntary—should be looking at the multifaceted problem of deafness in ageing as one of high priority. Many of the difficulties that I have outlined would be eased if there were greater awareness of the problems of deafness on the part of the general public and professional people associated with the care of the elderly. The elderly themselves surely have the right to better expectations of the alleviation of their problems. How encouraging it would be to break this important and bleak acceptance of the effects of ageing; and indeed the cost would be in inverse ratio to the benefits conferred. Much of what I have suggested would cost at any rate some money, but funds directed towards positive programmes earlier in people's lives could probably relieve the costly care and provision later in their lives.

I should like to draw your Lordships' attention to the Sympathetic Hearing Scheme launched last year by the Royal National Institute and other organisations in the sphere of deafness—with financial support from the DHSS—which aims to make everyday activities, such as shopping, simpler for everyone with hearing difficulties. The scheme uses the international ear symbol, which is being widely displayed wherever people with hearing difficulties can obtain special service. I should like to ask the noble Lord whether his department is likely to make available further funds for the continuation of this important scheme.

There is such a lot that can be done to help the deaf and hard of hearing people in everyday life which does not require the allocation of large sums of money. The Sympathetic Hearing Scheme, to which I have referred, promotes guidelines to be followed when dealing with anyone with hearing problems, and I should like to think that these guidelines can become an established code of practice and can be widely taken into account in schools, clubs, community organisations, et cetera, throughout the country.

Now I should like to draw your Lordships' attention to the following helpful points, in the hope that each of you will, in turn, mention them and commend them to others. I also hope that my noble friend will consider them as being suitable to form a simple code which would be available on a takeaway basis in general practitioners' waiting rooms or in chemists' shops. The first and most important point to remember is to get the attention of the person to whom you are speaking. Secondly, on no account shout. To shout is a common reaction, but it does not help, and only causes embarrassment. Speak slowly and clearly, but do not exaggerate your facial expressions, or distort your face. Try to face the light as well as the person to whom you are speaking, and try to cut out as much as possible of the background noise. Do not smoke, eat, or do anything that involves putting your hand in front of your face. Lip readers especially must be able to see your mouth. Use plain language. Many words look the same to lip readers. The more common the word, the better. If absolutely necessary, write down essential words. Those are some of the ideas—and I am sure that there may well be others—which I believe we can all put into practice with deaf people and which I should like to see in the form of an official code issued from the ministry.

I do not want this opportunity to pass without referring to the Chronically Sick and Disabled Persons Act, which has done so much to improve provision for handicapped people in general. As a result of that legislation, there has been wide discussion upon the many and special problems which handicapped people have in everyday life. This has resulted in marked public concern about mobility, self-care and so on. Sadly, however, into these discussions there rarely enter the problems of deafness—which, to my mind, seems to remain the Cinderella of the incapacitated. The much higher expectation of life will produce these problems in ever-increasing numbers. We want to achieve wide public awareness of deafness and to harness it.

Two hundred years ago, Doctor Samuel Johnson called deafness the most desperate of human calamities. It is still a desperate calamity. Deafness is not a killer but it is a destroyer. It destroys so much that is vital in our everyday lives. Relationships within the family, with friends and with those with whom we work are constantly under strain when there is a breakdown in easy communication. We are impatient and uncaring when sufferers misunderstand or seem outright dim. Rejection and isolation follow. It need not happen if there was more thought and sensitivity to what it means when one cannot hear normally. I beg to move for Papers.

6.32 p.m.

Lord Pry's-Davies

My Lords, we are all particularly grateful to the noble Lord, Lord Harvington, for having given us the opportunity of debating the problems of the deaf. The noble Lord puts the figure at 10 million people; the Royal Commission puts it lower at between 2½ million and 3 million people and from some 125,000 to 130,000 children and their families. They are people who are in isolation, who no longer hear the ticking of the clock or the song of the birds. My reading has taken me back to two basic documents, the 1975 Report of the Sub-committee on Rehabilitation of the Deaf and the 1976 and 1981 Reports of the Sub-committee on Services for Deaf Children, both documents having been addressed to the DHSS. Both sub-committees expressed surprise that more had not been done for the hearing impaired in the preceding years and that the service for the deaf was not more highly developed.

For example, the reports and the NHS commission drew attention to lack of collaboration between the NHS and the local authorities in the provision of services. The rehabilitation sub-committee found that there was even a lack of co-operation between the public and the voluntary bodies and a lack of access to centres of treatment and rehabilitation. The children's sub-committee called in particular for early screening of children, for screening to be administered to ail infants at about the age of eight months and for a review about the time of the child's third birthday. It emphasised the conclusion which is obvious to all: that delay in diagnosing hearing defects of young children can lead to permanent impairment of a child's development of language and speech.

The rehabilitation sub-committee criticised the almost total absence of follow-up caused by the lack of adequately trained staff in the NHS to carry out the skilled instruction that is needed by a large proportion of patients who could and should benefit from the services for the deaf. We have been reminded by the noble Lord, Lord Harvington, that due to the ordinary processes of ageing the elderly are probably the single group which makes the greatest demand on the services for the deaf.

All of us tend to get deafer as we get older and, although this interference with the quality of life goes on day in and day out, this can lead to social isolation. Nevertheless, the elderly are often slow to consult a doctor about the deterioration of their hearing. It is very difficult to educate the elderly to accept technological aids. It would be revealing to know how many patients have never used their hearing aid, although family and friends have prevailed on them to have one. One may well ask why spectacles are an acceptable aid but hearing aids are not.

The reports to which I referred, those of 1975, 1976 and 1981, focus the problems facing the services for the deaf. Because they focus the problem, this should by now have led to better facilities. I was chairman of the Welsh Hospitals Board between 1968 and 1974. I cannot now recall a single meeting when the board reviewed and set its priorities for its services for the deaf. Unfortunately, deafness ranked relatively low among our priorities—partly because there was little or no acute awareness of the problem but also because by the late 1960s (as your Lordships will know) the field was littered with critical reports calling for urgent reforms in facilities for the mentally ill, for the mentally handicapped and the elderly. The NHS had to respond urgently to these new pressures brought upon it.

I accept that the escalating pressures which exerted themselves at the end of the 1960s and the early 1970s have still not levelled off. Nevertheless, I think we are entitled to ask what improvements have been made in the service for the deaf during the last few years. The 1975 rehabilitation report called for the appointment of a new worker who would be called the hearing therapist. To this the DHSS made some little response. In the DHSS chief medical officer's report for 1981 we are told that there were 20 hearing therapists then in post and that eight students had commenced training in 1981 at the City Literary Institute.

By any standard this is a tiny number. How many are under training in 1982–83? How many are likely to be under training in 1983–84? Can the City Literary Institute train more students? If not, can more students be trained elsewhere? The children's sub-committee recognised the health visitor as being the ideal person to undertake screening for children under five years of age. Does the health visitors' scheme of study now include training in screening techniques for infants as recommended by the sub-committee? Can we ask when the last national survey of screening for defective hearing in pre-school children was carried out and what were the results? Has the number of health visitors been increased, as was suggested by the subcommittee?

In passing, may I mention that I understand that some parents have to effect an insurance in respect of hearing aids given to, or loaned to, their children by the area health authority; and they pay an annual premium of £24. Is this too heavy a risk for the NHS to carry?

Living, as I do, about a dozen miles from Cardiff, I appreciate the contribution made by the Institute of Hearing Research established at the University Hospital of Wales in 1979. There are related units at Southampton, Glasgow and Nottingham. I am informed that the unit at Cardiff has made a significant contribution to the deaf in South Glamorgan.

Can we be sure that the quality and range of service available at Cardiff, Nottingham, Southampton and Glasgow, is also available to the country in general? Beyond the reach of these four centres, how long is the waiting list? I understand on good authority that there is at least one district authority in my part of the world where people are kept waiting for two years between referral by the GP and appointment with a consultant. This appears to me to be too long. In passing, might I say that it is to be regretted that waiting lists are not published.

More and more emphasis is being properly placed on the prevention of handicap and impairment generally. During the last two decades the medical profession has become more aware of the damage to hearing that may be caused to people working in noisy conditions. Can we be assured that full weight is being given to this risk? What steps are being taken to ensure that noise levels at the place of work are being reduced, in alerting working people to the effect of noise, and in ensuring that the industrial worker who is exposed to excessive noise is adequately protected from the conditions in which he has to work?

It is not uncommon for industrial workers, who suffer a deterioration of hearing, like the elderly, to be slow to seek advice. Kemp and Kemp, the authoritative work on Quantum of Damages for Personal Injuries, in its stop press issue published in February this year, referred to the dearth of reported court awards for loss of hearing, but pointed out, and here I quote: There are apparently a large number of cases involving loss of hearing likely to come before the courts in the near future". In a judgment in the Court of Appeal in 1980 it was said that there were 2,000 writs outstanding against one large employer alone for compensation for damage to hearing, and no doubt the same kind of claims are being made against other employers in industry.

This brings me to technology and my final point. I understand, and probably we shall hear more of this this evening, that the main difficulty which the deaf experience with a hearing aid is that it is unselective and that it amplifies and distorts the noise in a room. It lacks the discrimination mechanism that allows the person who hears normally to distinguish the voice which he is looking for, or to distinguish clearly what is being said when two or three people are talking at the same time. But I also understand that, using micro-electronics, it should be possible to bring the same kind of selectivity to the impaired of hearing who relies on his deaf aid. Is the Minister able to confirm whether this by-product of micro-electronics is feasible within the next few years and at a reasonable price?

I appreciate that I have asked a large number of questions, and if the noble Lord the Minister is unable to come up with detailed information this evening, I should be grateful if the questions were noted by the department. As I have said, I am also grateful to the noble Lord, Lord Harvington, for having given me the opportunity of asking the questions.

6.43 p.m.

Lord Winstanley

My Lords, recollecting the recent brief argument we had in your Lordships' House about our rules of order and bearing in mind the advice recently given to us by the Select Committee on Procedure, I must not be too fulsome in my thanks to the noble Lord for introducing this subject, save to say he has introduced a very important subject indeed. I entirely agree with him that it is appropriate that this subject of the partially deaf should be raised in your Lordships' House.

I wonder how many of your Lordships recollect the noble Lord on this side of the House who was making an interesting speech, when he was suddenly interrupted by a loud voice from some remote recess in your Lordships' House with the words, "Speak up, please". The speaker stopped in his tracks with the words, "I am so sorry, my Lords, I had no idea anybody was listening". Noble Lords do listen; they listen with great care, but it is nevertheless a fact that some of them do not hear quite as well as they would like to do.

The noble Lord has focused his Motion on the general question of the partially deaf. I think it is right and sensible to do that because, in an era in which the age of our population is increasing, there is no doubt there will be a continual increase in the numbers who are partially deaf. It is entirely right that the problems of the totally deaf, or those who are tragically deaf from birth, are very different, very much more complex and perhaps much more difficult to deal with.

It is a fact, as has already been underlined, that the deaf are, in a sense, doubly handicapped. They are obviously handicapped merely by the fact that their hearing is impaired—which is a handicap in itself—but many are further handicapped because they suffer educationally as a result of their hearing impairment. It is an important subject and therefore I ask: what can we do?

First, we must look at the action we can take, and perhaps should take, in order to reduce the incidence of impairment of hearing. That means that we must pause, whenever possible, to look at the causes. I think I should be right if I underlined one of the causes and put it near the top of my list—that is, noise. I have no idea whether life exists on some other planet out in space. I doubt frankly whether the noble Prelate who is to speak shortly would know that. But, if there are other people up there somewhere else, they will know we are here. They will have heard us. We live on a very, very noisy planet indeed. I think there is some evidence that the result of noise in society is in part responsible for the increasing incidence of impairment of hearing. I hope we shall look at that.

We must also look at diseases of one kind or another which themselves contribute to the impairment of hearing: complicated and difficult subjects like Ménière's disease, which is arising with increasing frequency and perhaps increasing severity; disturbing things like tinnitus, and so on. More and more research needs to be done into those matters, their causation, their treatment and, if possible, their eradication. We must look again into the progress which is being made, although perhaps only marginally, into the incidence of genetic factors which are known to contribute in some way to the incidence of deafness in our population.

If we accept that we cannot always prevent deafness arising, certainly in an ageing population in which some deafness is merely part of the general degenerative process of age, deafness will obviously still arise. We must therefore turn to the action we should take to minimise the consequences of hearing impairment. First of all, I should underline something that has already been said. We must all learn to speak with much more clarity and we must also learn, as the noble Lord, Lord Harvington, has said, to make sure that when we are speaking, I hope with more clarity, especially to elderly people or people we suspect may have some impairment of hearing, we face the hearer.

It is remarkable how many people with partially impaired hearing lip read to an extent without perhaps always understanding that they do lip read. The noble Lord is entirely right in saying that we should not shout. It is rather odd that one has only to be in a wheelchair when one finds that everybody shouts. They seem to think that because one is disabled in one way one must be deaf as well. The noble Lord is right: shouting does not help, but clarity of speech does.

Here one must make a particular plea to the very young, who seem to me to speak with less and less clarity and less and less precision of articulation than perhaps we did in the past. My own grandchildren frequently tell me their grandpa is getting deaf. I say "No, it is just that you all mumble". They do mumble, and I hope that the schools will do something to improve the articulation of our children. If they do that they will certainly improve the lives of those children's grandparents. This apples not only to the young, but also to all those who work with the elderly. I think that among social workers there is not yet a sufficient understanding and realisation of the importance of clarity of diction and of articulation, and of facing the hearer when speaking and giving messages.

Let me turn now to the general question of hearing aids, which has already been referred to. It is an area in which we have made immense progress, though it is true that hearing defects vary. Some are more susceptible of assistance with a hearing aid of one kind or another, but many do benefit, and benefit very profoundly. It is a fact that we have now pioneered and developed much more acceptable hearing aids which are less obtrusive and more easy to wear.

I am very glad indeed that throughout the National Health Service, and through our audiology clinics, we now find it possible to issue the very small behind-the-ear hearing aids to a much larger number of people than was formerly possible. Nevertheless, it is still the case that, sometimes, the private sector can provide, privately, hearing aids which individual people find preferable and more suitable to their needs. I hope we shall make sure that the public sector, and the provision through the National Health Service, keeps pace with the very best in the private sector.

Let me now turn briefly to the question of subtitling of television programmes, films and things of that kind. That is admirable and it must be encouraged. Speaking as one whose hearing is not dramatically impaired, I would much rather listen to an Italian opera in Italian, with English subtitles, than listen to the same opera translated into English. This tendency to subtitle programmes is very helpful indeed to the deaf, but is is also quite acceptable to some who are not deaf.

Progress is being made in the television world, and there is an increasing recognition of these needs. If I may say something personal, as many noble Lords know, for nearly 14 years I have presented for Granada Television up in the North-West a kind of television information programme very much aimed at the elderly and at the under-privileged. Some five years ago, we started signing those programmes; in other words, in a little box at the corner of the screen we have a delightful and accomplished lady who signs the programme for those whose hearing is impaired.

Sign language is very attractive—very much like ballet, in many ways—and if one watches it one learns it. It is quite helpful. We have been signing those programmes for over four years without any damage to the programmes for other people, but to the great benefit of those whose hearing is impaired, and I venture to hope that many others will follow the example which we set many years ago up there.

Perhaps I may add to the general question of a little more research and effort into the provision of other forms of equipment and aid for those whose hearing is impaired. A great deal has been done. British Telecom have done some splendid work with the adaptation of telephones with volume control switches on them, and devices which in some cases can regulate the pitch of a telephone so as to make it very much more audible to people whose hearing is impaired. Work has also been done with the provision of doorbells, which are accompanied by a visual message of a flashing light, and devices of that kind, which are of great assistance to the elderly.

That is British Telecom. But what of British Rail? When the station announcer says, "The train now standing at platform so-and-so", those of us with the most acute hearing in the world cannot hear what is being announced. Would it not be better not only for the deaf, but for all of us, if, simultaneously, a visual message went up, so that we could all read it, whether deaf or not, and so that we all knew what the message was? So I hope that we shall add visual advice, as well as purely aural advice, in all those places where advice is given to citizens on one matter or another.

Leaving the question of action of various kinds in order to minimise the consequences of hearing impairment, let me just touch briefly on the subject which has already been referred to by the noble Lord, Lord Prys-Davies—the question of hearing defects caused by noisy work situations. Here there really is a problem. Over and over again, I have found that people who have been working in very noisy situations, and with very noisy devices, have not been wearing ear protectors which they ought to wear—probably because education has not been adequate to impress upon them the need to do so.

But I have one fear, which perhaps the noble Lord the Minister may be able to allay when he replies. I have the impression that, from time to time, we perhaps lag a little behind some of our European partners in our recognition of deafness as an industrial disease caused by industrial processes and, therefore, qualifying for compensation of one kind or another. I should like some reassurance on that point, because, certainly, we lagged behind some years ago and we may have caught up.

Finally, and to summarise, I should like to put one fairly general question to the noble Lord the Minister. It is a general question concerning resources and Government initiatives in general, and it is in a number of parts. I should like to know from the noble Lord whether there is a commitment from the Government to put effort, if not further resources, into the elimination of noise in our society. It is a factor. Some years ago, I carried out audiology tests on a whole lot of young people coming into industry, and we discovered quite a worrying degree of hearing impairment at certain pitches. I tended to think that it came from the level of noise to which they chose to listen in the discos in which they spent their evenings. I do not know. But we ought to do something to try to eliminate noise, whether it is aircraft noise, traffic noise or any other kind of noise.

Let us be clear, my Lords. What is noise? Noise is unwanted sound. For example, to me the Tannhaüser overture of Wagner is beautiful music. To others, it may just be noise. There are some youths to whom the desperate noise of a motor-bike is music. To me, it is just noise. So I hope that the Government will do what they can to eliminate noise, in the sense of its being unwanted sound, from our society.

Next, I should like to have some reassurance on the extent of support for research into the means of preventing deafness and of preserving hearing. I should like to hear a little about an increase in resources for the provision of aids of one kind or another for those whose hearing is impaired. That means not just hearing aids, but also the other aids which can make life a little safer and a little easier for those who are deaf. I should like to have reassurance on our standards of compensation for those whose hearing has been irreparably damaged as a result of working in a very noisy environment; for, despite the disappearance of the cotton trade and the old weaving sheds, there still are some very noisy working environments.

Finally, I should like to have some reassurance on the Government's backing of education for the community as a whole into the needs of the deaf and into ways of minimising the consequences of deafness. That means, surely, education aimed at higher standards of articulate speech among our society as a whole, and encouraging the public as a whole to understand the problems of deafness. If this short debate, which has been introduced by the noble Lord, Lord Harvington, has done anything to spread a greater understanding of the problems of hearing impairment, then it will have served a very useful purpose.

6.59 p.m.

The Lord Bishop of Southwell

My Lords, I, too, am grateful to the noble Lord, Lord Harvington, for initiating this debate. It is a difficult debate because it is not easy to define its scope. I am told that there are very few people who are totally deaf. The great majority of people have a tiny capacity for hearing, even if it is almost indistinguishable. At the other end of the scale there are few people who do not have some hearing deprivation, however small. On any estimate, therefore, the number of people we are talking about this evening is very large indeed—as the noble Lord said, about 10 million. As we are not talking about the profoundly deaf, for whom there is a lot of sympathy, let us note that we are talking about a sizeable minority of the population who do not stand out from the crowd, because, quite largely, there are so many of us that we are not noticed.

One of the things about the hard of hearing is that among their number are people with a wide range of hearing ability, a great difference of age at which their loss of hearing began, great differences in methods of communication, different attitudes towards their handicap, different intellectual capacities, personality traits and aspirations and, of course, very different sociological backgrounds. Unfortunately, society at large forgets these differences. People who have impaired hearing are regarded as just deaf, more or less. But the fact that they are real people with a wide variety of accomplishments and interests is generally forgotten, and part of the plight of the partially deaf is a vast ignorance of their problem on the part of the unthinking public.

Secondly, the plight of the partially deaf is also increased because of the lack of people trained to improve communiction between the hard of hearing and the rest of us. Some effort is made to help the hard of hearing to develop skills in lip reading and speech reading, but little effort is made to encourage the rest of us to learn how to communicate with the hard of hearing. We expect the hard of hearing to accommodate themselves to us while we make little effort to develop the necessary skills to talk to them. This is a legitimate complaint that the hard of hearing sometimes level against us.

Having said this, I believe there is need for a great increase in the number of people who are capable of teaching those who are becoming increasingly deaf to acquire skills in lip reading and speech reading. Some of those whose hearing is impaired or who have lost most of their capacity to hear acquire an expert ability to lip read or speech read, but even with such an expertise they experience severe limitations in their ability to get the full meaning of what is being said to them, as noble Lords have already pointed out. I am told that in fact in lip reading a relatively small proportion of the movements of lips and tongues are visible—probably not more than about 50 per cent. The speech reader has to rely on the context, the sense of appropriateness and even guesswork to determine what is being said. And, as has been pointed out, differences in the way in which people speak also contribute to the difficulties of speech reading. Talking too rapidly, or too slowly, or with very little movement of the lips, makes one very hard to understand.

In view of the tremendous obstacle to oral communiction, it is remarkable that so many people with hearing impairment make such sustained efforts to talk and understand what is said. We need many more people to train those with impaired hearing, and much more is needed to train the trainers. It would be ungenerous of me not to applaud what is already being set in hand in this field. In Nottinghamshire, which is the part of the country from which I come, there is in the University of Nottingham a Government-sponsored Institute of Hearing Research under Professor Haggard. The university's psychology department is also studying the psychological problems of deafness.

In our provision for further education in Nottingham there are at the moment only three full-time teachers of lip reading. Now, under the auspices of the Manpower Services Commission, there is a community enterprise project in the Bassetlawe district of Nottinghamshire which is using young people in a survey to discover how many hearing impaired people of all kinds there actually are. I mention this because in the country districts such people are very often not known to the social services, and certainly provision for helping them is less than in the big conurbations. My experience is that social workers employed by local authorities in this field are very dedicated to their work. My praise for those I know is unbounded. Most hearing impaired people nowadays have access to a social worker and, as has already been pointed out, there is an abundance of electronic aids. But despite all this there are many things still to be done, and in conclusion I should like to mention two or three of my anxieties.

First, while a lot of effort has gone into helping the physically handicapped—and quite rightly so—the hard of hearing, who come into the category of the disabled, come very low in people's priorities. While buildings are altered to accommodate wheelchairs, for instance, few buildings which have a public address system have an induction coil loop system to enable those with hearing aids to hear what is going on. All public buildings, including churches, should have this simple system installed and local authorities should be urged to give it a higher priority.

Secondly, mention has been made of the Chronically Sick and Disabled Persons Act 1970 which enables local authorities to make contributions to hearing-impaired persons, but this Act has recently become virtually a dead letter because of the cutbacks in Government expenditure which mean that town halls have little money to apply to this particular cause. More money must be made available as soon as possible to help those with impaired hearing if they are not to suffer very real deprivation. Thirdly, it is vital that the Government should give real encouragement to the voluntary societies working in this field. There is one particular situation which requires swift Government action. Voluntary effort has pioneered the Council for the Advancement of Communication amongst Deaf People, a project to which, incidentally, the churches have given their full support. It is a project which I believe is expected to be attached in due course to Durham University and it has the universal support of all the voluntary societies working in this field.

The council has, however, sufficient funds to continue its work for only three months. After that its work will cease. This council seeks to train interpreters, to keep a register of interpreters, to train lip readers. And—this is the important point—in all this they are involving deaf people themselves on the council on a 50:50 basis and are using them to train and assess these communicators. I believe that about a year ago the council approached the Department of Health and Social Security for help in funding this work, but nothing has so far been done. Only about £40,000 a year is required to set up and maintain this project. That is the sort of sum of money which voluntary societies find it very difficult to raise. It will be sad if the projects which have been set up under this council all over the country are all put in jeopardy. Cannot something be done to help this imaginative initiative which the voluntary societies together have set up?

The hearing-impaired are a truly remarkable group of people. Their achievements testify that it is possible to meet the challenge of this severe handicap. To do so is, however, very far from easy. Indeed, observational and experimental research indicates that it is extremely difficult for those with this disability to adjust to their environment. The failure in the past of some individuals to adjust adequately and the prospect of certain conditions worsening in the future are evidence that we need still better understanding of the problems created by deafness, better services and facilities for solving these problems, and perhaps better acceptance of situations which cannot be changed. I hope that this debate will encourage the Government to review their attention to the plight of the partially deaf.

7.10 p.m.

Lord Balfour of Inchrye

My Lords, I should like to thank my noble friend Lord Harvington for having initiated this debate. I must, of course, declare a most acute interest in the particular subject we are discussing this evening. I believe that in many cases partial deafness is to some extent due to our own past faults; that we have brought it upon ourselves. All we can do now is to regret our past errors and that we have done those things that we should not have done as regards the preservation of our hearing, and endeavour to warn the youth of this country of the dangers they face unless they take good care of their God's gift of hearing. Unless we do that we are neglecting our duty as sufferers from partial deafness.

All that we can do, now that we are getting on in years, is to avoid becoming social bores with our deafness in a world of swift and precious communication. Finally, we shall have to rely, as our deafness increases as the years go on, on the affection and tolerance of our friends and our families, because we shall be living in a social world divorced from the ordinary conversational world of other people.

It is for that reason that I believe in the acute need for education of the young, so that they will realise the precious gift about which I have just spoken. Progress has been made, but not enough. Today, in the age of the aeroplane, the danger of noise is at last appreciated. In the early days of flying—it was nearly 60 years ago when I started—we did not appreciate the danger of noise. We used to climb into an aeroplane, without goggles or a flying cap, and fly around. We were carefree. We enjoyed it. If you put an engine on a broomstick in those days, we would have taken it up. The RAF today is very different. The RAF makes it a very serious offence if an aviator, pilot or crew—or indeed a mechanic attending to an aircraft on the ground—does not use the properly supplied protective ear apparatus. That is the evidence of progress we have made in one direction. We should make progress in other directions, too.

We could make progress in the area of shooting. Shooting is not done by just one class. It is done by agriculturists at every social level. We used to shoot and shoot until our partial deafness was absolutely sure. Many of us had the choice, when we went to have our ears tested, of giving up shooting, as we were advised, or to continue. I confess that I said I would continue shooting. I am probably suffering for it now, but I had an awful lot of fun while I was shooting.

There ought to be proper education about the maintenance of standards of hearing. I should like to see the National Health Service embrace regular ear testing for young folk and so give them warning if their hearing is starting to deteriorate. I believe that school lectures are required, not ramming the dangers down their throats, but occasionally bringing home to the youth of this country the dangers of the real risk in their later lives unless they take care of their hearing now.

Finally, I wish to put a question to the noble Lord the Minister. Today we have hearing aids, but as was said by another noble Lord, hearing aids intensify sound but do not analyse sound or the direction from which it comes. I hope that the noble Lord the Minister will be able to tell us that progress is being made in improving the selectivity of hearing aids. I hope that I may look forward to a future in which the deaf can have an aid with a switch whereby all sound except that beaming down from one particular individual will be washed out; but, by moving the switch the other way, one will be able to hear noise coming from all quarters.

I believe that this technique of sound selectivity is something that we shall see being developed in the future, and I hope that the noble Lord the Minister will be able to tell us tonight that progress is being made in this particular direction. I hope it will come about that the deaf person will be able to take part in conversation apart from the noise outside and then, when he requires, embrace all the other forms of noise. That is my hope, and I trust that the noble Lord the Minister will be able to give us some small comfort in that direction tonight.

7.17 p.m.

Lord Clifford of Chudleigh

My Lords, it was 13th May 1981 when I raised this subject in this Chamber by way of an Unstarred Question. I was declaring my interest, and in doing so I explained that I was the deafest Member of your Lordships' House. This was followed the next morning by my being tackled in the bar by the noble Lord, Lord Balfour of Inchrye, who practically challenged me to a duel for making that claim. So this evening, in declaring an interest in this subject, I will start by saying that I agree to share with the noble Lord, Lord Balfour of Inchrye, that particular honour. I should also add a declaration of interest in that I happen to be president of the West Regional Association for the Deaf, and president of the Devonshire Association of the Hard of Hearing Clubs.

When I last raised this subject two years ago, the debate was limited at that time to the various hearing aids which were available for the deaf. On that occasion we mentioned those aids which we were all hoping would get some boost, such as the television aids for the deaf; Ceefax, Oracle, and Teletext facilities. There have been other developments of great assistance, but these developments can be of use only if the Government are going to give some assistance, because they are expensive. If these aids are going to be left just for the few who can afford them, they will never achieve the object behind them. For the very deaf there is the Link, an essential telephone aid, the electronic mail via the telephone, writing on the television set, Vistel. There must be a Link for the people who have got to the furthest stage, and that is what a lot of people interested in this subject are worried about now. If you can get the Link, add that to the Vistel, the electronic mail, you have got a part of the deaf world who can communicate with their fellow beings.

The Sympathetic Hearing Scheme, to which Lord Harvington referred, is of great help, but it is not widespread. The loop has been mentioned. Before we used the loop—when I say we, I am talking about the annual general meeting of the Devonshire Association of Hard of Hearing Clubs—imagine me, as a deaf person, taking the annual general meeting; it was the fun o'Cork! Nobody knew if anyone else was talking, and if they did they did not know what he was talking about. There were people on the side doing sign languages and others doing lip reading. It was impossible. I thought, "It is no use my going along any longer". At any rate, the year before last I went along as usual to our hall in Exeter, and in came a man with this apparatus. For those who do not know, the loop is a coil which is put around the room, a little box of tricks; it is plugged in with half a dozen microphones. Then deaf people can switch their hearing aids across to the telephone. It was the first meeting that, as a result, ran smoothly. I then found out where I could get one and installed it at home. Now I can sit down by the fire in the evening, my wife can pick up one of the two microphones we have, and something gets through, instead of her having to bang her head on the floor the whole time. Life is a little more normal.

Another advantage is that one can have a switch-down attached to the television set. That enables one to adjust the sound to what is wanted without blowing ordinary people out of the room by the noise. Might I suggest that we should have that in the television room here? I think that the loop would be a much better thing in this House than the equipment we have now. These are all things that are of interest to the deaf. But what I am interested in more than anything else is that they should get down to the ordinary people, the ordinary old-age pensioners and so on, whose lives are so cut off.

With regard to lip-reading schemes, we need more lip-reading teachers. I was fortunate in having the same teacher as Jack Ashley, so I have heard a lot about what goes on, because she was one of the trainers of lip-reading teachers. Unfortunately she has now retired. Turning to sign language, I may say that we have a number of sign language teachers, but we need more in order to enable so many of the population, as there are now, to communicate and to get together, because there is a very great deal of misery in the country from loneliness caused by deafness. I am certain, from my experience, that it is only through the hard of hearing clubs, and so on, that we have saved many suicides.

Operations are now coming into effect. In Australia they have invented a bionic ear through a 2.2 million dollar Government grant. I hope the noble Lord will take the hint. In America they have had a similar device, invented by the University of California, which is used by the University College Hospital over here. Here it is funded by a private charity. I am hoping before long to have a talk with Dr. Ellis Dovek of Guy's Hospital to see if I can persuade him to extend his operation successes, again not to the totally deaf but to, so to speak, the fairly deaf.

The trouble about all these devices is that they are useful only for the low notes; and the high notes are what most of us miss and are the ones that need to be heard. Years ago I asked a doctor whether I could not have an operation for deafness. He said, "There has been one experimental one on dogs in America and it cured their deafness". I said, "So there is hope?", and he said, "Yes, but they all died of spinal meningitis". So we want to know a little more than the odd things we read in the Reader's Digest or the New Scientist. My Lords, if one is blind one is cut off from things; if deaf, one is cut off from people. We deaf people have a large chip on our shoulder apropos the blind; we feel that they have had a proportionately larger slice of the cake than we have.

Finally, I think it would help if people could realise that if they want life for deaf persons to be not too unbearable, there should be some education. I went to a mixed oldies-youngies fancy dress party about 10 years ago. All I did was put a notice round my neck saying, "Deaf, not daft". One of my sons crossed out the "not" and put "and", but that does not matter. Before he went back to school I took a young son to a barber's and left him there while I parked the car. There were two barbers, George and Bill, and as I came in my son said, "George died last week". I heard it in some other way and said, "Jolly good show!", and of course the other barber dropped the scissors down his neck. These things go on all the time. We talk too much; it is a defensive mechanism; it is so much easier for us to talk than to listen. That makes us rather unpopular. At other times we are considered rude, or else we interrupt unknowingly. I got ticked off by the noble Lord, Lord Strabolgi, once. I turned to him and saw that his lips were not moving and said something. He gave me hell; he said, "Can't you see I am talking to so and so?". I had not seen that; I had seen that he was not talking, but he was listening.

Another trouble is that we either talk too loudly or too softly, and that depends on the hearing aid. Perhaps I may close in emphasising that point by telling your Lordships a story of the old Irish lady who was very deaf. She went to confession. Her battery was down, and she shouted her sins so loudly that the whole church heard it. The priest arranged that the next time she came she should hand in a list. So, six weeks later she handed in the list. There was a long pause and then the priest said, "But this is a shopping list". "Holy Mother!" she said, must have left my sins in Tesco's".

7.30 p.m.

Baroness Nicol

My Lords, I consider part of my allotted time well spent in thanking the noble Lord, Lord Harvington, because I think we have had a most useful discussion. I hope that it will eventually have some effect, although I was rather depressed to be told today that these debates are seldom taken up and used. I hope that does not prove to be so in this case and that there will be some result from it.

We seem to have had different figures given to us about the number of people affected by partial deafness, but we are all agreed that it is a very large number. My own figure is that, of those over the age of 70, 50 per cent. will be suffering some sort of hearing disability. That in itself is a frightening enough assumption. We now have 9 million pensioners. Happily many of them will live well beyond the age of 70, but it is a very sobering thought that 50 per cent. of them will need help. We have had a very fair coverage of the difficulties suffered by deaf or partially deaf people, but one that has not been mentioned, except indirectly, is the depression which is a very real part of being deaf or partially deaf. I understand that this applies to all age groups and social classes. Depression is a very real and tangible effect.

I want to come to all that is left to me after the excellent speeches made so far: that is, some practical suggestions about what we can do to help deaf people generally. If there is nothing wrong with one's eyes one can go to an optician, and there is an optician in almost every high street. Why can we not have some sort of hearing aid centre, or a centre for not just hearing aids but environmental aids as well? If a person needs help with his hearing he can go to the hospital, but the hospital only deals with hearing aids. It does not deal with environmental aids. Quite often a hearing aid is dished out to someone who, in fact, only needs a television amplifier, a flashing door bell or some other much less expensive and much less difficult to follow-up means of being helped. So why can we not have these centres? I remind your Lordships that the cost of hearing aids came down dramatically when the National Health Service did some bulk buying. Why can we not have bulk buying of these other aids, which would bring the cost down not only to the National Health Service but also to the private sector? There would be benefits all round.

The area of training technicians has been well covered but I highlight one reason why we need more technicians and more investigation. It has been discovered in research that the very old do not take kindly to being fitted with hearing aids. However, if people with a disability at its early stages get help and are fitted with aids they will continue to use them and will upgrade them as necessary right into their old age. Therefore, it is very important that people should be attended to, not necessarily in their youth because one hopes they will not need it, but in their 50s and 60s when these disabilities begin. They should establish the habit of wearing hearing aids, getting attention and not being self-conscious about it. We need much more ease of approach for those with hearing difficulties and we need many more technicians, not only to attend to them in the first place but to follow them up afterwards and make sure that the aids they have been given are properly used and not just discarded.

We underestimate other aspects of being deaf and perhaps I can mention them because it does not hurt for those of us who can still hear quite well to be aware of them. I refer to the danger to people when they cannot hear. Alarm bells cannot be heard. Traffic horns cannot be heard. All kinds of difficulties at work arise; workers are unable to hear changes in the machinery note which would be a warning to those who can hear but is not heard by those with hearing difficulties. We should bear those difficulties in mind and press the National Health Service, or employers, to make sure that visual aids are available as well as warning sounds.

Finally, what is mostly needed is somebody, or something, to co-ordinate these efforts because at the moment they are fragmented. In 1981 ACSHIP existed—the Advisory Committee on Services for Hearing Impaired People. This, for reasons which I have not discovered, was disbanded in 1981. Perhaps ACSHIP was not the best thing that could have been done, but something like it is still needed, if only to make sure that the money that is available in the health service and elsewhere is properly spent. The Government would do well to consider replacing that body, or setting it up again if that is the best thing, but certainly give someone the responsibility for co-ordinating the services for the deaf.

At the beginning of the debate the noble Lord, Lord Harvington, said that our civilisation depended on communication, and so it does. If we are to cut off about 10 or 20 per cent. of our population from that civilisation, then we are failing in our duty and I think that, if nothing else, this House has done well to draw attention to that.

7.38 p.m.

Baroness Vickers

My Lords, I am very pleased to have the opportunity of speaking in this debate because I am chairman of a new organisation called Cued Speech and, like the right reverend Prelate, I am in desperate need of money to keep it going. It is the newest method from America and it is working very well, having been going for two or three years, but we are existing from month to month. I did even more than the right reverend Prelate about seeing the Minister from another place. I even had him to lunch, but unfortunately that was wasted money because we have heard nothing, and that was nearly a year ago.

One of the difficulties is that most people are kind to disabled people but deaf people look perfectly splendid. One does not realise that they have anything wrong with them at all. That is one of the difficulties. If people do see a hearing aid they are perhaps shy of going up to speak because they do not know how to tackle it. Fortunately, I am not shy and I have been well trained by my noble friend on the Front Bench to speak up and to take an interest.

One is apt to think, as has been found in this debate, that most deaf people are rather elderly. As a matter of fact there are over 2,000 schoolchildren who are partially deaf. They are the children we must think about for the future. About 6 per cent. or 7 per cent. of the 10,000 children who have already been tested have hearing defects and they therefore need special education, but there is not enough special education or trained teachers to do this.

The statistics also show that there are educational, social and emotional problems with these children that are of very deep significance. Of these children, 95 per cent. could be properly trained if they had the opportunity of having further education. But they do not. Only 23 per cent. get further education after the age of 16. It is also considered that communications between schools and the outside organisations are very poor. The agencies that could help these young people to get jobs are not tackled.

The Rowson Report on deafness to the DHSS referred to a departmental inquiry into promotion and research. I am afraid that very little promotion and research is going on in a big way. It is very badly needed. I hope that noble Lords in their areas will press for this and will also continue to press the Minister. I think that it is one of the bad spots in our education at the moment of partially deaf children.

For the younger ones, for babies shortly after they are born, there are some instruments: boxes with little cradles in the middle. I have been to Hillington Hospital to see these. I think that there are only three of these in the country at the present time. They are for babies of a week old or more. Two little pegs can be put in their ears. If the baby flinches at all, you know that it is all right; if it does not flinch, you know that it needs its ears attending to. This can be done straight away when the baby is about one week old. I have watched the babies; they do not mind a bit. It does not worry them. They do not cry.

Children with average hearing loss (that is, of less than 65 decibels) have a very poor reading attitude. Children aged 16 have a reading ability of only an eight to 10 year-old. I agree with noble Lords that television is a great asset. In the West Country they have a little box for the old fashioned fingering. I want to get away from the old fashioned fingering and get new methods into teaching the deaf. Some of them are protesting. I have little battles with them. Some of these methods have been used in this field for over 100 years, but I do think that it is now time that we had new methods. The method that I am interested in is cued speech. I have had several demonstrations here to show noble Lords and other Members who are interested. It is easy to learn. The French have taken it up in a big way and even the Indians in Bombay have a very good school for this.

It is excellent that we are really thinking of something. This, regrettably, is done in America. It is regrettable from our point of view. They can get the money to carry it out. They do not have perhaps so many old institutions and they are very much keener than we are on this. There are to be—and I have seen them on videotape—spectacles which at the moment cost 850 dollars a pair. People will be able to read speech through their eyes. They would take a long time to explain, and I have not got many minutes, but there are little boxes on either side and little tapes and wires going up either side of the nose to the glasses. They reflect the speech of the person. They will be absolutely excellent. I only wish that I had a pair here. At the moment I cannot afford to buy a pair and, indeed, there are only the three or four pairs going. I hope to show the videotape again when we have our annual meeting here in about two or three months' time. I hope that anybody interested in this will come to see it.

In regard to the question of the cost for television, I gather that the difficulty is that it would cost over £1 million to do what people want. They say that it would need £400,000 to pay the people to work it: the engineers, clerks, et cetera. That does not seem a great deal when it could give enormous pleasure not only to the deaf people but to others who could look at the television at the same time. If it is worked out properly, you would not have to have two televisions. I hope that today we shall consider new methods and interest more people in the deaf.

I can tell what I think is a rather sad story, in a way. I belong to the Royal Commonwealth Society for the Blind. We get over £1 million a year through the voluntary organisation. We started one for the deaf and we had to close it down because we could not get enough money to keep it going. People are not sympathetic to the deaf, not because they do not wish to be, but there is nothing to show them the need. This is the trouble, I think. I hope that today's debate will highlight the great importance of this. As one or two people have said already, there will be many more deaf people later on, especially if they go on playing in those very noisy dance bands. Some of them are already having trouble with their ears, which is another point we have to remember.

I am very grateful to my noble friend Lord Harvington for introducing this debate. I am looking forward to talking to him nicely over the week-end in Jersey, as he is coming to a conference that I am having there. I should now like to ask the Minister whether he can give us a very favourable reply indeed.

7.44 p.m.

Lady Kinloss

My Lords, we are indeed indebted to the noble Lord, Lord Harvington, for introducing this debate today. It is time that this subject was ventilated, because, as others have already said, deafness, partial deafness or some loss of hearing is likely to afflict most of us sooner or later. There are many and various ways in which the hard of hearing can be helped today. The British Association for the Hard of Hearing is a registered charity. Through a network of 220 local clubs, social, eduational and community activities are organised and ideas, experiences and information are exchanged.

It is self-evident that people who have problems with hearing cannot read other people's minds, but with training and help they can read lips, and this or anything else which helps communication is obviously a help. It not only aids in overcoming a feeling of isolation—being cut off from their fellow human beings—but also helps in getting to know people. Mr. Peckford, who was senior social worker for the deaf in North Yorkshire, has said about lip-reading, and I quote: It seems to work for some people. It doesn't really matter what can be proven technically about a person's lip-reading ability before and after a set period of instruction. What's really important is the way an individual feels about it; if he feels he now has the confidence to enter into a conversation which previously he would have gone to considerable lengths to avoid". Surely, this is important. Lip-reading tuition has long been recognised as an important part of rehabilitation for people who have become deaf in adult life. In many areas lip-reading classes are charged for at the LEA class rates: surely they should be free for these disabled people. They may not be so obviously at a disadvantage, such as the blind with a white stick or a guide dog, or those unfortunate enough to be in a wheelchair, but they can be in just as great a danger from traffic, to take one example.

In North Yorkshire, where I live, lip-reading with adult education classes is free, as it is regarded as rehabilitation rather than further education. They also have two social workers especially trained, who give signing classes, and they find that there is a growing demand for these classes. They go wherever they are needed, not only to community centres; they also visit families at home if the facilities are suitable, especially those with profoundly deaf children. They find that for the family continually trying to communicate with a deaf child is a great strain, but there is a desperate need for them to do so if the child is not to feel cut off and unloved, and this for a family is a very real disability. North Yorkshire social services find themselves in the unusual situation of needing two more social workers who have the additional training in communication skills. They have the money for one more, but cannot find even one with these special skills. I wonder whether the Minister can help.

Current research has shown that as many as one person in five may have a significant hearing loss in one ear. One of the causes, among others, is excessive noise. Gone are the days, on the whole, of commuters having to put up with transistor radios. In their place are stereo headphones. For as little as £10 the young can plug into a portable boogie box, as I understand they are called, and enter their own private world of harsh noise. Peaceful as the world may be for those such as parents who no longer have to put up with the noise, there is great hidden danger for the young person who uses these headphones.

There is evidence coming to light that the continuous high-level noise blasting straight into the ear can cause permanent damage to a person listening for a long time. Would the Government consider having a warning put on the advertisements for the sale of these headsets of the danger of possible future impairment of hearing for those who use them, such as the health warning they now have on packets of cigarettes? Not only can the noise cause impairment; it can just as much cause death if a young person crossing a road does not hear the ordinary traffic sounds. That also applies to those riding bicycles who wear them.

One area in which great advances have been made is the sub-titling of films by the television authorities. The All-Party Disablement Group, of which I am a member, were given details of the development plans for the sub-titling of programmes by the BBC, but only viewers with television sets capable of receiving Teletext can obtain these sub-titles. It was hoped that by the end of a five-year expansion programme the BBC would be sub-titling all pre-recorded programmes broadcast at peak hours on BBC 1 and BBC 2. They also hope to experiment with sub-titling football matches and other public events with the use of live interpreters as well as what is called palantype. I think the BBC are to be congratulated and this must be of great encouragement not only to the hard of hearing but to all of those who either teach or are involved in any way with the hard of hearing.

On Sunday night we had a very touching broadcast from Mr. Terry Scott; I trust that many saw it on BBC 1 at 6.35 p.m. He said, however, that a Teletext set cost £50 more a year to rent than ordinary television sets. In the discussion with the All-Party Disablement Group, which I have already mentioned, we were given to understand that it was only about £30. I wonder whether the Minister who is to reply could enlighten us on which is the more accurate statement. Perhaps the difference is between the hire of a colour television and a black and white one. I am sure that he will readily understand that the difference between £30 and £50 means a lot to pensioners and others on small incomes in that one is nearly double the other. Once again I express my gratitude to the noble Lord, Lord Harvington.

7.52 p.m.

Lord Wallace of Coslany

My Lords, I, too, would like to express my very grateful thanks, as I am sure the whole House does, to the noble Lord, Lord Harvington, for introducing this debate. He has been rather quiet lately, but I remember him as a very excellent Chairman of Ways and Means in another place. Perhaps he might give the Government some financial advice on finding the ways and means to provide some of the things that people have been asking for in this debate tonight.

This is an important issue and it concerns a handicap which is not often discussed. There are many people suffering from deafness who are too embarrassed to admit it and consequently they are not receiving proper treatment. Mention has been made of discos. I am not a disco fan, but I think that some of the excessive noises in discos present a considerable danger to people's hearing. Some years ago in Sierra Leone we were given a farewell reception by the parliamentary people and that reception included a very loud band called the "Guinea Girls" from New Guinea. The ceiling was low and, frankly, apart from my ears being affected I felt my chest going in and out with the pressure of noise. I think that excessive noise is a considerable social danger as far as hearing is concerned.

I come to the point which was made by the noble Baroness, Lady Vickers, who is obviously involved with some of these very highly technical new developments. This subject was also mentioned by my noble friend Lord Prys-Davies. I am referring to the very important question of checking deafness at an early age. The Department of Health and Social Security, as the Minister indicated when he almost interrupted the noble Baroness, has a number of auditory response cradles on test at one or two NHS hospitals. I understand that the screening by this method began in 1978. It is, indeed, a revolutionary development in testing the hearing ability of a very young baby. Detection of any defect in hearing ability at an early age is of prime importance for the child's future care and education as well as of help to the parents, removing often extreme anxiety. The equipment is not too costly, and the Minister will probably confirm that it costs about £8,000 per piece of equipment. Compared to the beneficial results which can be achieved, it is money well spent. I wonder whether the Minister can give the House any further information on this project? How is it going on? Has the department approved it and, if so, although expenditure control is, I know, a problem, is it possible in any case that voluntary organisations such as hospital friends (with which I am very much involved) could assist in the provision of such equipment? Such a facility can be of vital importance.

I turn next to the older deaf children. So far as schoolchildren are concerned, even slight deafness can affect a child's ability to absorb a teacher's work. Teachers in the main are very alert in detecting signs of handicap such as deafness, partial or otherwise, and refer the child to the school doctor and thence on to the family GP for possible further treatment. In this field, however, a very serious problem arises when the child is found to be in need of training at a special school for the deaf. I understand that it is becoming a real problem to find places for children in such special schools due to economy measures and for other reasons. Unfortunately, I must admit that this is not a new problem, but it is one that must be handled with a sense of urgency. Special schools can achieve remarkable results and it would be a pity if such valuable work were undermined because of mere financial considerations.

I now come to the general problems of the partially deaf. In this connection I am raising points which have been submitted to me by a lady who is partially deaf—the very charming wife of my noble friend Lord Underhill. Lady Underhill has given me a number of points which she thinks I ought to raise—and who am I to say no? For those equipped with a deaf aid living in outlying areas some distance away from a hospital, there is a need for easier facilities for maintenance and other problems associated with the aid. On the whole our postal service is good, but to use it is not always convenient, especially if the deaf aid has to be surrendered for repair. I realise that it is a question of expense, but in fact every patient should have a spare aid, particularly in the circumstances I have just mentioned, but also in case a fault arises. People regularly wearing spectacles normally have their previous pair readily available and it is wise to make sure that they are readily available or indulge in a spare pair. But normally this is not the case with a deaf aid.

So what is the position? Is it possible for spare aids to be made available particularly for those people who have to travel and be away from home from time to time? There is also the need for uniformity in aid design—that is, on/off switches and volume control switches should always be in the same positions. My informant complains about the "Madescro" aid which is worn on clothing. It is claimed that this type of aid should be scrapped or issued only on request. It is also claimed that they are socially unacceptable, especially to sensitive people. Every body or clothing movement is amplified, reacting noisily to certain materials more than others. Has the department received any similar complaints? Another complaint is about the need for an ear mould that fixes more easily. Some aged or somewhat infirm people find it difficult to know how to insert it and this sort of confusion detracts from the benefit of an aid, as well as causing worry and frustration.

I now move away from the complaints submitted to me, and I should like to make some general points, many of which have already been mentioned. For example, there is the loop system which is vitally important and which is now being installed in quite a number of theatres, especially new civic theatres. This, of course, is a tremendous advance. But deaf aids are only part of the story, particularly for the person living alone or alone for part of the day. There has been mention of door bells and the need for a flashing device. Some people have them. Then there is the alarm clock problem and, again, the need for a flashing device or a vibratory system. Telephones are another hazard unless assisted by amplified hand sets, extra earpieces, extra bells, or today even visual telephones. Mention has been made of Teletext, which is proving a great boon to the deaf.

All this and other things must mean additional expense to obtain a reasonable everyday life for a deaf person, an expense which a great many are unable to afford. I must admit that many items are zero rated for VAT purposes and in some cases are free of VAT. But even so the question of expense remains. I should like to ask—and I am almost putting forward a begging bowl—whether there is any way in which assistance can be given on the financial side to help those people who are unable to afford some of these vital and necessary additional aids. Also, is it possible that such expense can qualify for tax relief, of course where a person is in a tax-paying position? Indeed, perhaps the end solution is a comprehensive handicap allowance.

Returning to the general subject of deaf aids, can the Minister say what is the present supply position and what measures are being taken to overcome any shortfall in supply? In the National Health Service there always seems to have been a supply shortage of deaf aids. I agree that some people can secure their own aids privately, but, private or public supply, no one with hearing problems should attempt to obtain an aid without previous medical tests or advice. I say this because I have always maintained it as regards spectacles and it also applies to deaf aids, because in the testing some other physical defect might be revealed. The choice of National Health Service or private is one for the individual, but it would be unwise, as with eyesight, as I have already said, to go ahead without medical advice or examination.

Finally—and I am anxious to give the Minister ample time for reply because I have a hint that he might have some goodies for us; I hope so—as with many other forms of disability, voluntary organisations play a vital part in service to the deaf. Nationally we have four main bodies generally known as the Panel of Four, all doing excellent work. Apart from these there are many other local organisations; and, like the noble Lady, Lady Kinloss, I should like to pay particular tribute to the British Association of the Hard of Hearing, run, as it is, by deaf people for themselves. Its admirable efforts in providing clubs and so on are to be welcomed and supported.

However, I am not sure what system of co-ordination exists between the DHSS and these bodies, if any. But there should be the closest possible link-up to assist not only those unfortunate people whose hearing is impaired, but also to educate and advise the fortunate majority of the general public on how they can deal with communication with the deaf and the social problems which necessarily exist today mainly due to ignorance and lack of understanding. Once again, I should like to thank the noble Lord, Lord Harvington, for raising this very vital subject—and it is about time.

8.4 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)

My Lords, although there is a good deal of time left, I understand that it is the convention that even so the Minister does not try to speak for the 40-odd minutes or so that are left. I have a good deal of material in front of me and I hope, therefore, that your Lordships will forgive me if I go at a fair pace. Any point that I fail to take up now, I shall naturally try to deal with by correspondence at a later date.

I should like to begin by adding my thanks to those of the rest of your Lordships to my noble friend Lord Harvington for initiating this important debate on the plight of the partially deaf. It is difficult to get to grips with the problems of those whose hearing is impaired because they are by no means a homogeneous group. Hearing impairment, however serious, is an invisible handicap and does not often attract a great deal of sympathy from the general public. If this applies, as it does, to those people who are unfortunate enough to be born profoundly deaf, with all the difficulties they face through never having heard the human voice, it certainly applies to those who—late in life perhaps—lose their hearing to a greater or lesser extent.

To understand their difficulties requires an effort of sympathy and imagination which those of us who are more fortunate often seem unwilling to make. We are uncertain what to do when we meet someone whose hearing is impaired. We want, I hope, to do the right thing and to smooth the way as best we can, but we lack knowledge of the problem and we need guidance as to the best approach to make. But when we consider the difficulties of those whose hearing is impaired, the loneliness and sense of isolation which some elderly people in particular suffer, we must do something about their plight. If they cannot even hear a knock at the door, if they are unwilling even to seek help—and this is not rare—then we in the hearing world have a duty to do as much as we can to improve their quality of life and break down their social isolation.

I have indicated that there is a lack of public understanding of the problems and needs of partially deaf people. A survey conducted by the OPCS for the Department of Health and published in 1981 found that the general public were sensitive to the needs of deaf people, but they did not know how to deal with them and did not know how to communicate with them. For example, this communication barrier creates a particularly distressing obstacle in public places, where failure to hear an announcement over a loudspeaker or public address system can have serious consequences. The public need to know more about what it means to be deaf and how they can provide positive help in day-to-day contacts with deaf people. Sometimes all that is needed is a little time, patience and effort, but it also needs to be said that hearing-impaired people will often not admit to having a handicap and do not seek help.

As in so many aspects of social welfare, the voluntary organisations have shown the way in the field of hearing impairment. As a Government, we are determined to foster and support a strong and progressive voluntary movement, for the charities can often do what statutory organisations cannot. Great praise for their efforts over many years is due to both local and national organisations helping deaf people. Not surprisingly, given the fact that deaf people are, as I have said, not a homogeneous group, there are several organisations in this field, and they can be most effective, especially when they combine their efforts to mount projects which are of help to all deaf and hearing-impaired people. My honourable friend the Minister for the Disabled meets the four national organisations who comprise the so-called Panel of Four formally every year and there is constant contact between them and the various Government departments which are concerned with aspects of the problem of deafness.

The Panel of Four comprises the Royal National Institute for the Deaf, the British Association of the Hard of Hearing, the National Deaf Children's Society and the British Deaf Association. A shining example of the way in which they have worked together recently is the Sympathetic Hearing Scheme referred to by more than one noble Lord. This aims to make everyday activities like shopping simpler for everyone with hearing difficulties.

The scheme uses the "ear" symbol, which looks like this and which has been adopted by organisations for the deaf throughout the world. It is displayed wherever people with hearing difficulties can get special service. British Telecom have been putting it in telephone kiosks, where it indicates that the hand-set is fitted with an induction coil for hearing aid wearers. Shop owners display the symbol to show that they are prepared to help and encourage deaf and hard of hearing people to use their shop. Plastic cards displaying the symbol have been produced for people whose hearing is impaired. Members of the public are asked, when shown one, to give the holder a fair and sympathetic hearing. On the back of the cards are the basic appeals: Please speak clearly and not too quickly. Turn towards the light and face me. Cut out as much background noise as possible. Don't be afraid to write things down. The Sympathetic Hearing Scheme was promoted and financed jointly by my department and the Panel of Four. It was launched in 1982 by my honourable friend Mr. Rossi, and the department initially provided £20,000 towards the scheme. The purpose is to increase public awareness of the problems and needs of people with impaired hearing, and the scheme has had a successful start. For example, it has been taken up as part of the Duke of Edinburgh Award Scheme for the community service element of the Silver Medal.

The Panel of Four are now again combining to give a greater impetus to the scheme and are seeking more support from sponsors in order to advertise and develop it further. They have appealed once again to the department for financial help and I am pleased to announce here tonight that my honourable friend has decided to award a further grant totalling £200,000. This substantially increased sum is being given in the light of the initial success of the scheme. We are confident that the scheme will go a long way to help those who are hard of hearing and enable the general public to know how to help them in a useful and friendly way.

My noble friend Lord Harvington in his opening remarks suggested that the Government should introduce a special code for communicating with deaf people. I have already referred to the code which appears on the back of the Sympathetic Hearing Scheme card. This covers many of the points to which my noble friend referred. I feel that it might be as well to wait until we see how successful this has been before deciding whether the Government might introduce something further.

One of the most effective ways of helping is the provision of a hearing aid. Your Lordships will share my pleasure that in recent years it has been possible to improve considerably the range of hearing aids available under the National Health Service. No longer are people restricted to the old body-worn aid, although for those who prefer it and those for whom it is most suitable, this is still available. Now one can obtain, free of charge, the small and powerful models which are worn discreetly behind the ear. The range of hearing aids generally available under the National Health Service now meets the needs of all but a very few patients, and for these, local health authorities have the power to purchase a special model. I have to agree, however, that hearing aids are not selective enough. One or two noble Lords referred to these difficulties. But we need to know more about the fundamental mechanisms of the impaired ear before the opportunities offered by modern micro-electronics can be utilised.

There is, however, still need for improvement, as I have said. I myself have been very much aware of the inadequacies of present generation hearing aids as used by small children in particular, and I have myself asked the Medical Research Council to consider them in particular in the context of its forthcoming work on design requirements for hearing aids. But in this country we can now say with pride that we have a comprehensive hearing aid service for everyone. The noble Lord, Lord Winstanley, referred to the provision of hearing aids on a private basis, and the noble Lord, Lord Wallace, referred to that too. But, as I said earlier, local health authorities are empowered to buy whatever special hearing aid may be necessary and available, without necessarily having to draw upon one of the aids more generally available through the National Health Service.

Of course, improving the range of hearing aids available under the NHS is important, but it is important too that patients should be enabled to make the best use of their aids, and that those who have special difficulties in adjusting to their impairment should be given further help. Recognising the importance of follow-up care, my department has provided central funds in order to set up the new profession of hearing therapists. They are mainly concerned with the rehabilitation of adults suffering from acquired deafness. There are now nearly 30 in post in England and a further ten commenced training in September 1982. This was particularly on the mind of the noble Lord, Lord Prys-Davies, when he was speaking earlier.

The hearing therapists' scheme has been a pilot scheme which is now being examined to see how effective both the training and the service provided are. Once we have received the results of the research we shall decide whether, and how, the scheme should be extended. But no matter what the extent of hearing loss, it is vitally important to discover it as soon as possible. The department emphasises the need to screen children at an early age so that action can be taken quickly to diagnose, assess and treat any child in whom a hearing loss is suspected. Screening of children at 8 months, 3 years and at school entry is continuing. Its effectiveness is being examined, especially that done by health visitors. I can assure your Lordships that training in such screening is given to health visitors. We are examining this in training to ensure that the highest standards are maintained. That too was on the mind of the noble Lord, Lord Prys-Davies.

Auditory screening tests on tiny babies are difficult to perform and are not always effective. Now I come to the interest of my noble friend Lady Vickers. Recently, however, there has been a most interesting development in this field, and my noble friend referred to it during her speech. With the help of Government funds a device has been developed which can test the hearing of newly-born babies. That is called the Linco-Bennet Auditory Response Cradle, which uses a computer to analyse the baby's response to sounds delivered automatically. The cradle provides an objective test. It should improve coverage, since testing would be conducted in the maternity unit before the mother returns home with her baby.

I visited a hospital recently where research is being carried out on the cradle—and I think my noble friend said that she had been there too—and I was able to announce on the occasion of my visit that the Government are purchasing eight more cradles to enable the evaluation programme to be speeded up. The noble Lord, Lord Wallace, asked whether even greater acquisition of cradles could not be moved forward. We are still in the stage of evaluating this cradle and it might be wrong to encourage leagues of friends, for example, to acquire great numbers of these devices before the evaluation is complete. However, I should say that the initial results of the evaluation are very encouraging indeed.

One of the most important issues affecting hearing-impaired children is their education, and I must say something about this. Education is central to their development and has a great bearing on the kind and quality of life they will lead as adults. With the implementation of the 1981 Education Act on 1st April the educational category "partially hearing" will disappear, together with the other nine statutory categories of handicap into which children needing special educational treatment are currently divided. The Act, of course, follows the concept recommended by the Warnock Committee of making, where necessary, a multi-professional assessment of the child's educational needs as a whole rather than concentrating on his specific disability.

The Act, as a Bill, was given considerable time in your Lordships' House, and I shall not, therefore, dwell on the benefits which it will bring to all children with special needs. Under its provisions the hearing-impaired child will be educated in ordinary schools with his hearing contemporaries where that is the right thing to do in his particular case. But special schools, or units, equipped to deal with the hearing-impaired, will continue to be available for those children who need them. The disappearance of the "partially hearing" label opens the way to a broad, more flexible approach to educating these children. It does not imply in any sense a less clear recognition of their need for help or any impoverishment of the provision we are making for them.

For children suffering from any significant loss of hearing early identification is critical, and the sooner intervention and education begins the greater will be the likelihood of positive and lasting benefit. The Act opens the way for educational arrangements to be made without delay wherever they are required. It also requires health authorities to inform local education authorities of children under five who come to their notice and who seem to have special educational needs, thereby providing a framework within which early identification and action are encouraged.

My Lords, may I just turn now to a few of the points made during the course of the debate this evening. The noble Lord, Lord Prys-Davies, in his speech referred to the delays at hearing-aid centres. Temporary factors have indeed created some difficulties for hearing-aid services throughout the country, and where there have been additional local problems the backlog of work in some cases has become rather large. Part of the problem has been the shortage of trained staff to take audiological measurements and to fit hearing aids. However, of greater importance has been the extension of the range of aids available through the centres, especially the higher power models, which has created additional demand. I am informed that these problems are past their peaks, and it is now agreed that steady improvement can be achieved in the health authorities concerned. The Government prefer to leave it to the health authorities to manage their resources according to local needs and priorities.

The noble Lords, Lord Prys-Davies and Lord Winstanley, referred to the occupational deafness scheme. Occupational deafness was first included in the schedule of prescribed industrial diseases in 1974, but cover was, however, limited to certain very noisy occupations mainly in the shipbuilding and metal-working industries, and to people who were substantially disabled by deafness.

More recently, in November 1982, a further report by the council concluded that, although some constraints will have to be maintained, there is scope for widening the range of occupations still further and easing the restrictions imposed by the 20 years' and 12 months' rule. The council has therefore recommended that occupational coverage should be extended to include work with high-speed woodworking machinery and with chain saws, and people working in the immediate vicinity of most prescribed processes. The council has also recommended that the 20 years' rule should be reduced to a minimum requirement of 10 years' employment in one or more prescribed occupations, and that claims should be permitted up to five years after leaving any prescribed occupation, instead of 12 months, as at present. Those recommendations are all under consideration. I am afraid that I cannot tonight announce any Government decision on them, but I hope that an announcement will be possible before long.

The noble Baroness, Lady Nicol, asked me about the Advisory Committee on Services for Hearing Impaired People. The Advisory Committee—ACSHIP, as it is called—was set up in 1974 to advise the Secretary of State for Social Services on aspects of health and personal social services for the hearing impaired. It did not address itself to technical aspects of hearing aids or audiological equipment, which were the subject of separate advisory committees—one called the Advisory Committee on Audiological Equipment. ACSHIP set up five committees, which reported on specific topics and produced recommendations for the statutory authorities and for practitioners. ACSHIP was wound up in 1980, when it had completed its final report on services for hearing impaired children. Ministers now receive advice from medical and other professional advisers within the department, who keep in contact with professionals in the field, including service members of ACSHIP.

Several noble Lords mentioned aids such as visual doorbells, inductive loops, and similar gadgets. These are listed and described in a report produced by my department, and perhaps I may place a copy of the report in the Library of your Lordships' House.

The noble Lord, Lord Winstanley, and my noble friend Lady Vickers referred to research into hearing impairment. On the subject of research, let me first say that I was very heartened to learn that a recent survey of research projects in the United Kingdom relating to hearing and speech and their disorders, identified no fewer than 395 separate projects current in 1982. This is a very encouraging level of research activity.

The noble Lord, Lord Winstanley, asked in particular about research into prevention of hearing disability and preservation of hearing. Much hearing loss is of course the consequence of ageing, but work continues on studying identifiable causes of deafness, with a view to their elimination. Several noble Lords referred to the difficulties in discos, and I should not be surprised if in the fullness of time that noise turns out to be a cause of deafness in later life.

The noble Lady, Lady Kinloss, asked me about the difference between prices for ordinary and Teletext television sets. I am sorry that I do not have in front of me information about that, but perhaps I may look into it and write to the noble Lady.

The noble Lord, Lord Wallace of Coslany, referred to the possibility of supplying spare hearing aids to hearing impaired people. These are made available in a very limited category of cases—for example, to those people with additional visual handicaps—but it would be extraordinarily expensive to extend that provision to people using hearing aids generally, and I fear that I cannot give an undertaking that we can offer any real prospect of doing that.

Time marches on. I do not think that I have spoken for quite so long as the board indicates, but I hope that what I have said will serve to underline the Government's concern for the plight of those whom we have been discussing this evening. Much has been done to ease their problems by both statutory and voluntary services, but I am sure that more could be done to improve their quality of life still further. However, I hope that the points that I have sought to make tonight, not least the announcement that I was able to make just now, will serve to convince your Lordships that the present Government—indeed, like their predecessors—care for these people and are making important and improved provision for their welfare.

Lord Harvington

My Lords, I think that it would be the wish of your Lordships if I were to express your feelings on the debate that we have had—it has been most interesting—as well as our gratitude to the noble Lord, Lord Trefgarne, for dealing so fully with the points we have made. But perhaps above all I should thank him for hard cash, because it is not very often that a debate such as this ever results in any Government announcing hard cash. Although I have been in one or other of these places for 45 years, I have never before seen it happen quite like that. So, on behalf of us all, I thank the noble Lord, and following upon that, I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.