HC Deb 26 March 2003 vol 402 cc93-100WH

11 am

Sandra Gidley (Romsey)

I welcome the opportunity to put the matters in question before the Minister. This is beginning to feel like a regular event. I have long been aware that audiology could be regarded as a Cinderella service in the NHS, but I have only just realised how far the local service has deteriorated in the three years since my election.

I have a letter from a constituent, highlighting the fact that in June 2000 there was a 12-month waiting list. The waiting time runs from the hospital's receipt of the GP's referral letter to the date of the hearing test. It is important to bear in mind that the wait is for a hearing test only, and that a further wait follows before a suitable hearing aid is provided. The good news for my constituent was that we managed to bring her appointment forward. She was an elderly lady and had to wait only about three months. That is important: at one time local hospitals' policy was to bring forward appointments for very elderly people, but that policy has recently changed.

Since October I have received a significant number of letters from constituents informing me that the waiting list for a hearing test is anything from 27 months to 29 months. Clearly, that situation is unacceptable. The first question that I asked myself was whether the problem was unique to Southampton. It might be instructive to tell the Minister about my first encounter with the Royal South Hants hospital, where hearing tests are performed for the Southampton University Hospitals NHS trust. I was initially put through to a fairly junior member of staff who was very helpful, but who, upon realising that I was an MP, clammed up completely and said, "I really don't know if I should be talking to you." She checked, and told me that the boss wanted to speak to me. The then boss was forthcoming about his department's severe underfunding, and the reasons for it. Quite simply, audiology is not, or was not, a priority.

I suspect that the problem is not unique to Southampton, because the evidence shows that the Department of Health has been aware of such a problem for some time. On 7 June 1998 the Department of Health issued a press release that stated: Latest figures show the NHS is continuing to make good progress on cutting long waits for NHS patients. Clearly audiology is not part of those figures, but I am not sure why. In December 1998 the then Under-Secretary of State for Health, the right hon. Member for Barrow and Furness (Mr. Hutton), responded to issues raised by my hon. Friend the Member for Richmond Park (Dr. Tonge) by saying: I assure her that we are absolutely committed to ensuring that people who need audiology services from the NHS get a first-class service. Nothing else will do."—[Official Report, 2 December 1998; Vol. 321, c. 854.] I do not know the NHS definition of a first-class audiology service, but in my book it is not a wait of 27 or 29 months.

Between December 1998 and August 2001 the number of people throughout the country waiting more than 13 weeks for an initial audiology appointment rose from 491 to 1,529, according to Government figures. Clearly the hype does not match the reality. In 2001 the Royal National Institute for Deaf People produced the report "Audiology in Crisis", which highlighted lengthening queues for audiology services. It stated that the funds allocated by trusts for acquisition of hearing aids are in most cases inadequate to meet demand, even using the most basic hearing aid technology. That fact, together with inadequate staffing and infrastructure, is a major threat to the successful roll out of the Government's initiative to modernise hearing aid services.

The important point that arises from what I am outlining is that in many cases the funding available to audiology departments has struggled to keep up with inflation. Bearing in mind the many other calls on NHS resources that may be understandable, but it is set against the scenario of a rapidly ageing population that naturally gives rise to a greater demand for audiology services. What assessment have the Government made of the likely increase in demand for audiology services, and what predictions are made for the future?

I attempted to verify the waiting time figures provided by the RNID, but it was impossible because the Government do not collect the figures in a useable form. That is a signal that the matter is low on the list of priorities, so trusts are all too ready to divert resources elsewhere in order to meet Government targets. The background to the matter is inaction and a scenario in which the only topic of discussion—worthy though it is—has been the provision of digital hearing aids. Digital hearing aids are important, but any excitement at the prospect of receiving one wears off with a wait of about three years from referral by the doctor.

Naturally, when letters about waiting times of 27 or 29 months began to hit my desk, I was concerned and wrote to the agencies involved and to the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), who has responsibility for public health and for the area that I am concerned with. Her reply, dated 12 November 2002, stated: I have been informed by Southampton University Hospitals NHS Trust that waiting times for hearing tests at the Trust are indeed 29 months as a result of the number of referrals received. The Direct referral Access service, which was set up in 1994, was based and funded on a maximum of approximately 500 patients a year. The demand for this service has however increased to approximately 1500 patients a year. The situation is clearly unsustainable, but apparently is being ignored by Ministers, because the reply continued: I have been advised by the Trust that it is presently working on ways to get additional funding for this service. Then followed the words that always make my heart sink: A local Audiology Steering Group has been set up to consider ways of reducing the waiting times for patients by working closely with the primary care trusts"— I shall return to primary care trusts shortly— ensuring more resources are made available to improve the service and exploring ways of working within the GP practices for assessments. There will be frequent validation of the lists". I am not sure what that means, but the cynic in me says that it involves frequent checking so that those who have died or used the private sector can be removed from the list, as a way of cosmetically improving it. I was informed that there would be a review of staff skill mix within the department and a support mechanism for patients on the waiting list that require information". I hesitate to guess at what sort of support mechanisms will make people feel happy about the fact that they do not have what they want, but I should be interested if the Minister could clarify that; clearly they do not deal with the basic problem. The Under-Secretary acknowledged that the changes would take time.

I wrote to two of the primary care trusts in my area and was interested to receive a letter from the Eastleigh and Test Valley South primary care trust, confirming that the Minister had outlined the situation correctly and describing some of the measures that the trust had taken. It stated: An early step was to apply queuing theory and reduce the number of queues to be seen by giving priority only to those in urgent clinical need. The phrase "queuing theory" worries me slightly, but no one could argue about those with greater clinical need receiving a better service. The letter continued: This routine checking of patients on the list, and the introduction of audiology technicians has already reduced the wait to 21 months at the beginning of February". I shall return to the figure of 21 months later, because it is wrong, but I should also point out that the letter went on: The back log of people waiting for hearing assessment is significant and even if limitless funds were available there are recruitment issues in audiology services which have been compounded by changes to the duration of the training for new audiologists". Clearly, with a primary care trust quoting a figure of 21 months and constituents quoting a figure of 27 or 29 months, I needed to form an accurate, up-to-date picture of the situation in Southampton to convey to the House, so I contacted the audiology department at the Royal South Hants hospital yesterday. The staff were extremely helpful and confirmed the following waiting times: those in the Eastleigh and Test Valley South primary care trust are waiting 27 months for an assessment or a reassessment. My constituents in Bassett, which is part of the Southampton City primary care trust area, are waiting only 17 months for an assessment and 21 months for a reassessment. I asked why that significant difference had arisen, and the answer was quite simple: it is because the city primary care trust is slightly ahead of its neighbours and has invested in the service by funding extra staff. The aim is that by April 2004 the waiting time for audiology services will be 13 weeks, which will bring it into line with the waiting time target for other outpatient services. I thought that that picture was stark and could not get any worse, but I discovered that waiting times in New Forest PCT, which is not part of my constituency, are 31 months for assessment and 29 months for reassessment. I was also told that the Eastleigh Test Valley South PCT was now considering ways to give more money to reduce waiting times.

So what is happening to those people on the long waiting lists? Quite simply, some have no choice. They will have to wait for almost three years for a hearing aid while their hearing slowly deteriorates, which can have a significant isolating effect. People may decide not to attend noisy functions because it is suddenly all too difficult to communicate. Others may decide to try to access the private sector, as a constituent, Mr. Leo King, reluctantly did. He says: I should keep you up to date with my further enquiries on this subject thus: I went for further private hearing tests a week ago. The first was in Winchester at Winchester Hearing where the process took about 2 hours and the decision was that I needed an aid in each ear at a cost of approx £2200. The next appointment was in Verwood at a superbly equipped office ߪ where I was given an extremely professional examination utilising what appeared to me to be the latest equipment but the result was the same and the cost much of a muchness (£2300 but more advanced product). In each case the cost was the total for both ears. Hidden Hearing is still much more expensive than this (I understood ߪ that an up to date comparison would be £5400 for Hidden Hearing) As I am now pretty desperate and cannot wait for the NHS to perform as I believe it should I shall be taking up the offer from the Verwood. That is from a gentleman who I believe is in his 60s, who has accessed NHS services only through his GP. He has been to hospital only once in his life, and feels aggrieved at not getting a fair service after investing what he considers to be so much in the NHS.

Mr. King continues: This is what I think the NHS assumes—ie that if the delay period is long enough it becomes a matter of urgency for the individual so he/she is more or less forced to seek a private alternative. Thus the waiting list becomes 'shorter' for which the NHS will then claim success. Sorry to sound so cynical but I truly believe this to be the case. I must point out that this gentleman had to e-mail me. I had come across him on Saturday night in a noisy social setting and he had difficulty hearing me, although it was not so noisy that I could not communicate with other people. How much worse would his condition have got in two and a half years' time? His e-mail gave me cause for concern. The prices that he quotes are high, but I know that the cost of hearing aids to the NHS has dropped to a two-figure price. The price that people have to pay in the private sector seems unacceptably high, even accounting for the fact that the NHS has the advantage of its purchasing power and that premises and personnel have to be paid for. Will the Minister say what control the Department of Health has over non-NHS provision of hearing aids, as the costs seem to be high? After all, we are talking about medical devices.

I mentioned that Eastleigh and Test Valley South PCT is considering possible funding, and I understand that it may be applying for the next tranche of modernisation money. However, I am unclear about what measures the Government have taken to encourage PCTs to apply for the funding. I understand that the closing date for applications is tomorrow, but will the Minister say how many trusts have applied and how many trusts the Department of Health has actively encouraged?

The problem is clearly exacerbated by the lack of audiologists in the country. When the Labour party came to power, there were only 30 audiology consultants in the country. Waiting lists have tripled, but the number of audiology consultants remains stagnant. Last March, one of the Minister's colleagues admitted to me in a parliamentary answer that there was a drastic need for an increase in the number of audiology consultants above and beyond the 11 proposed by 2010 under the NHS plan.

The Government are clearly well aware of the need, but will the Minister outline what positive measures have been taken to address the problem that one of his colleagues has acknowledged? The Audit Commission described audiology as a Cinderella service. The key reason for that is something to which I alluded earlier; namely, that the statistics are not formally collected and published. The lack of statistics leads in turn to audiology being treated as a low priority. Although it is not the only solution, the setting of waiting time limits and the collection of statistics on how they are being met would greatly help to improve the situation.

I call on the Minister to make an assessment of future needs and to agree to fund the training of the necessary numbers of staff. I also ask him to investigate the private sector to see if there is any evidence of undue profiteering and overcharging. Last, but by no means least, it is imperative that audiology services are included in the range of services for which the current target for waiting lists is 13 weeks. Only then will the service receive enough attention and funding from the PCTs, and only then will my constituents be able to receive a humane and timely audiology service.

11.16 am
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)

I congratulate the hon. Member for Romsey (Sandra Gidley) on securing today's debate. I believe that this is the third time in the past two weeks that we have had occasion to take part in an Adjournment debate together, and I commend the hon. Lady on the assiduous way in which she has brought the concerns of her constituents to the House.

This is an important issue, which the Government take very seriously. I am grateful that the hon. Lady, at least at the end of her speech, outlined the grave situation that we inherited in 1997—the lack of consultants throughout the system and serious under-capacity for people with hearing difficulties in this country. We have started to improve services from that very low standard, and I reassure her that the Government are attempting to do all that they can to support not only her local PCT and local health economy, but health economies throughout the country.

Major investment and a challenging modernisation programme are spearheading work on improving the way in which audiology services are being delivered locally, and to ensure that patients receive an efficient and high quality service, including the population in Southampton and south-west Hampshire.

I concede that the NHS hearing aid service does not have an impressive record, as some of my colleagues have also said since 1997. That poor record was a result of under-investment that went on for too long. From the 1960s to modern times, people have been given old-fashioned hearing aids. Problems with recruitment and training of audiology staff and access to services have all contributed to a situation in which patients wait far too long for an assessment.

Let me reassure the hon. Lady that steps are being taken at a local level to address the issue. Southampton University hospital trust has a target whereby all priority patients receive a hearing test within three months of referral. Priority patients include those who are registered blind or partially sighted, war pensioners whose pensionable conditions include hearing loss, and those in clinical need. I am pleased to report that that target is being met. It is important that we acknowledge those steps.

Discussions are continuing between the trust and local PCTs as part of the current local delivery planning process to identify ways of reducing waiting lists for all patients. Southampton City PCT has invested an additional £100,000 to recruit additional staff, as the hon. Lady said, and to reducing waiting lists for hearing assessments to 13 weeks by April 2004.

The PCT has achieved significant improvements, and waiting times for assessment have halved from 34 to 17 months over a 12-month period. It is right that we commend the Southampton PCT for that achievement, while acknowledging that it still has some way to go.

I am pleased to hear that the Eastleigh and Test Valley South PCT and the New Forest PCT are in discussions with the trust about their involvement in the modernisation process. I am sure that the hon. Lady will do all that she can to support the PCTs and the trust to move that process forward.

I acknowledge that although Southampton City PCT has made progress in that area, its neighbouring PCTs have much to do. The hon. Lady put the waiting times on record, and those times are unacceptable. However, the Government are doing all that they can through the Modernisation Agency, and I would encourage the hon. Lady to work with the neighbouring PCTs to meet the challenge. so that they are on course for moving those waiting times downwards.

Modernising the service requires investment, and I am pleased to report that in the recent three-year allocation announcements the average growth for Southampton City PCT, Eastleigh and Test Valley South PCT and New Forest PCT was 9.6 per cent., which is above the national average.

Local health economies will say to the Government that they cannot modernise without funds, but in the hon. Lady's area they have those funds. This year they are receiving record allocations from the Government.

Sandra Gidley

I cannot help challenging the Minister on that issue. He said that we have the funds in my area. The Winchester health authority, in particular, regards itself as being one of the worst-funded in the region. If the funding is adequate, why is my local hospital, which is a three-star organisation, running at such a severe deficit at present?

Mr. Lammy

The hon. Lady will know that we started from a base of under-capacity in the NHS. The Government have done all that they can to build that capacity. We have been sensible about that—we have a 10-year NHS plan, and therefore have some way to go before the end of that 10-year period.

I put on record today that the hon. Lady's area has not only had an above-inflation rise in the amount of money available to invest in the local economy, but an extra 9.6 per cent. has been announced this year. We are doing all that we can, nationally, to assist her local area.

We are proud, as a Labour Government, that we have been able to say to the public that we will put national insurance up next month to continue the year-on-year investment in the NHS, so that we can reach the same level of investment in our health economy as our European partners. I say to the people of Southampton that we are on a journey, but that we are doing all we can.

A number of developments demonstrate the priority that is being given to audiology services in Southampton. I am pleased to say that a joint appointment for a head of audiology will be made between Winchester and Eastleigh Healthcare NHS trust and Southampton University Hospitals NHS trust. The post holder will promote best practice procedures across both areas and will help to make the best use of capacity across the system.

The NHS work force development confederation is also funding a new degree in audiology, which has been launched at the university of Southampton for 42 students. This is part of a national programme, pump-primed by the Department of Health, to address the recognised shortage of audiologists.

I acknowledge that such local action needs support at a national level, and I hope that I have outlined some of that support. The modernising hearing aid services programme is a new and exciting programme that is revolutionising the way in which audiology services are delivered. It will make digital hearing aids available for people at all NHS sites that provide hearing aid services. Up to 1.8 million people with hearing impairment, including 18,000 children, will benefit from leading-edge digital hearing aid technology. We are, therefore, moving forward from the old-style hearing aids that people were receiving until recently.

In April 2000, the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), announced a breakthrough in NHS hearing aid services, centred around the patient. He said that we would be testing out the benefits of providing leading-edge, high technology digital hearing aids as part of a modernised NHS. The aim of the pilot was to test new-generation hearing aids that could be adjusted to meet individual requirements, and to ensure that they were made available to those who would benefit.

The results from the original pilot, which was tested out in 20 NHS trusts, were positive. Researchers found that people with digital hearing aids were hearing better, and using their hearing aids more. The research also showed that digital hearing aids offered people a 40 per cent. improvement in hearing and quality of life.

The public can often be left with the impression that debates in the House are just words. However, a 40 per cent. improvement in a person's hearing and quality of life is important, and the fact that 1.8 million people will benefit is something of which we should all be proud.

Since that time, we have extended the new service. The target was that 50 NHS hospitals would be providing digital hearing aids in a modernised service by this month and that a further 17 would be ready to start from April 2003. We have already invested more than £30 million to support that work. To the end of February 2003, more than 72,000 digital hearing aids had been fitted since the start of the programme, benefiting more than 47,000 adults and 600 children.

We recognise that there is still a long way to go to make the new digital service available everywhere, and that that requires significant investment. That is why, last month, the Secretary of State announced an extra £94 million of investment during the next two years to ensure that those hearing aids will be available throughout England by March 2005. The plan to roll that out will mean that a further 80 sites will provide a modernised service in 2003–04, and the remaining 70 will do so in 2004–05—the aim is to achieve full roll out across the country by March 2005. That will mean that the benefits of high quality digital hearing aids will be available, free of charge, on the NHS, to everyone who needs them.

I reassure the hon. Lady that the issue of waiting times has been an important consideration for the project team and the Modernisation Agency team. Those teams are working with the NHS to help it to tackle increased demand and to keep waiting lists as low as possible.

Sandra Gidley

Why does there appear to be opposition to including audiology services in the 13-week target that applies to other outpatient services?

Mr. Lammy

I hear what the hon. Lady says. However, my Department has responsibility for optical services, pharmacy, dentists and emergency care, and groups of stakeholders in all those areas could ask the Department whether they could be included in that particular target. The threshold must be set somewhere, but there will always be those who would have preferred it to be set somewhere else.

In conclusion, I reassure the hon. Lady that the subject that she raised is a key issue for the Department, and that significant steps are being taken to improve audiology services and waiting times in Southampton and across England. We aim to ensure that everyone who has a hearing impairment has access to a top quality service regardless of where they live. The modernised services that are being rolled out will help to ensure that that becomes a reality in her area and in others.

11.29 am

Sitting suspended until Two o'clock.