§ Mr. Christopher Chope (Christchurch) (Con)The NHS audiology service is in crisis. Although the Government have decided that digital hearing aids should be available to all by April 2005, freely at the point of need, they are manifestly failing to deliver the means necessary to achieve that objective.
I make no apologies for illustrating the depth of the crisis by referring to the situation in Christchurch, east Dorset and Bournemouth. More than 7,000 people are waiting for a hearing aid assessment at the East Dorset audiology centre, which is run by the Bournemouth primary care trust. In the last period for which figures are available, between April 2003 and November 2003, the East Dorset audiology service carried out 177 hearing aid assessments a month and 150 hearing aid fittings a month. Unless something dramatic happens, those who join the waiting list for a hearing aid assessment now will have to wait well over three years before it is conducted. Even the waiting lists for those in greatest need—those aged over 90, those who have no hearing whatever and those who are war pensioners—is one year just for a hearing assessment. There is then a further period of around six months before hearing aids are fitted.
It will not surprise you, Mr. McWilliam, that the primary care trust does not publicise the fact that its current waiting time is between three and four years. It cites instead the length of time that a patient being assessed this week has had to wait. That is currently about 18 months, which is bad enough, but if a person joins the waiting list today their wait will be more than 39 months, unless something dramatic happens as a result of this debate.
I hope that the Minister will confirm that she believes, as does the primary care trust in Bournemouth, that waiting times are unreasonable and excessive. If she does not agree, can she explain the finding of the health service ombudsman in the complaint against Southampton University Hospitals NHS Trust that
it is unacceptable for patients to wait two years for a hearing assessment.She will be familiar with that case, which is cited in the latest summary of the ombudsman's cases. If it is unacceptable for a patient to wait two years for a hearing assessment, how much more unacceptable is it that they should have to wait more than three years? If she does agree that the current waiting times are unacceptable, I challenge her to tell us what the Government intend to do to address the crisis.One of my frustrated constituents wrote to the Prime Minister about the situation on 22 May 2003. He received a response three months later from the Department of Health. expressing horror at his hearing problems and appreciating his concern at the length of time that he had had to wait for an audiology appointment. The Department of Health official said:
Let me assure you that the Government shares your concerns about waiting times. Their vision is to provide patients with fast and convenient access to health care wherever they use the system…Thanks to the continued hard work of staff across the NHS, steady progress has already been made. Maximum waiting times have already been reduced to twenty one weeks for a first outpatient appointment".67WH That was totally misleading. The waiting time for audiology services locally is increasing, rather than decreasing, and is now seven or eight times the maximum referred to by that Department of Health official in the name of the Government.Good hearing is fundamental to the quality of life. Elderly people in particular should not have to wait years to gain access to a service that is immediately available in most high streets, albeit at a price that for many is unaffordable. In audiology, as in so many other policy areas, there is a growing chasm between what the Government have promised and what is actually being delivered. One straightforward way of improving matters would be for the Government to pay for any NHS patient who has not received an out-patient hearing assessment within six months to have the service provided at NHS expense with a registered private practitioner.
In a written parliamentary question, I asked the Minister's colleague, the Under-Secretary of State for Health, the hon. Member for South Thanet (Dr. Ladyman), about the possibility of that happening, but he did not give me the courtesy of a straight answer. I hope that the Minister will remedy that situation today and will not fall back on the notion that a private sector partnership initiative, conducted by the Bournemouth primary care trust, is sufficient to deal with the backlog. In the past five months alone the backlog for Bournemouth has increased from about 5,000 to 7,000 cases, despite 300 patients benefiting from a private sector partnership. There are plans to provide a further 700 patients with treatment under a private sector arrangement next year, which I welcome, but that will make only a small dent in the backlog.
One of my constituents sent me a copy of the Royal National Institute for Deaf People leaflet for deaf and hard-of-hearing people entitled "A Good Audiology Service: What You Can Expect". Page 5 of that leaflet says that waiting times should not exceed the following:
From date you are referred to your GP to date of first visit or assessment not more than four weeks. From assessment visit to first hearing and fitting appointment not more than four weeks.I wrote to the chief executive of the RNID, Dr. John Low, about this. In his charming reply, he said:'A Good Audiology Service' outlines what audiology services should work towards, and what patients should be able to expect but does point out that not all services are able to deliver to this level at the current time.On present trends, the East Dorset audiology service will never be able to meet the RNID aspiration—that is unless the RNID changes its aspiration from four weeks to four years.I have attempted to ascertain whether the situation in my locality is unique or whether members of the public seeking access to NHS audiology services elsewhere in the country are experiencing similar delays. It appears, however, that the Government refuse to collect any statistics on the subject, despite having been advised most strongly so to do by the Audit Commission in its report "Fully Equipped" of March 2000.
On 5 January, the Minister's colleague, the Under-Secretary of State for Health, the hon. Member for South Thanet, assured me that 68WH
all audiology departments in England will be fitting digital hearing aids routinely by April 2005."—[Official Report, 12 January 2004; Vol. 416, c. 593W.]I then asked him if he would list those audiology departments that do not fit digital hearing aids routinely at present. On 26 January, he replied that the Department of Health does not hold centrally a list of audiology departments in England.That is bizarre. The Minister's colleague purports to speak for all audiology departments, but when he is pressed he is unable even to list them. Will the Minister undertake to start collecting information about NHS audiology services so that she is able to back up policy assertions with facts?
I share the belief of the RNID that waiting times for audiology services suffer from not being part of the national standards for waiting times. Pressure is put on local health trusts to satisfy national standards for services other than audiology to the inevitable detriment of that service. It is well established that centrally imposed targets distort clinical priorities. Therefore, the target system should either be abandoned or it should embrace audiology. Does the Minister regard NHS audiology services as an issue of national, or only of local, importance?
On 20 January, in a written answer to a question of mine about audiology departments, the Minister's colleague said:
It is for primary care trusts to plan these services in response to the needs of their local communities."2014;[Official Report, 20 January 2004; Vol. 416, c. 1105W.]Is that the full extent of ministerial involvement?It is estimated that 8.7 million people in the UK are deaf or hard of hearing. Currently, about 2.7 million of them have a hearing aid. The Medical Research Council has estimated that a further 3 million people would benefit from wearing one. If a national health service means anything, surely it should embrace a national plan for responding to the hearing needs of the people?
On 18 December, I asked the Minister's colleague to list, in respect of each primary care trust, the number of people waiting for a hearing assessment and the number waiting for more than six months. He responded:
there are no targets for waiting times for audiology services".— [Official Report, 5 January 2004; Vol. 416, c. 175.]However, he also felt confident enough to say that the Government are taking action to tackle the causes of longer waits. It is well known that if something cannot be measured, it cannot be controlled. The reality is that the waits are becoming significantly longer rather than shorter.As with so many other taxpayer-funded services, the Government are quick to brag about the financial inputs but seem far less concerned about the outputs. What is unreasonable about my suggestion that all those waiting for more than six months should be able to elect the private sector option to be paid for by the NHS? What about my suggestion that the NHS should pay for those who obtain digital hearing aids on the continent? The RNID members' magazine includes glowing reports on how UK customers can have their digital hearing aids fitted to a very high standard in Denmark at a cost far lower than in a UK high street and at a time when they need them rather than three or four years later. There is 69WH much anecdotal evidence that people are organising trips to Denmark so that they can access audiology services, which should be available to them in this country and provided by the NHS.
On 6 February 2003, the then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), issued a press release entitled "Digital Hearing Aids available to all by April 2005". We may come to regard that headline as one of the most misleading ever issued. His words must have been calculated to fill a million hearts with hope. He raised expectations by saying:
These digital hearing aids cost the NHS up to £75 per aid and will be free to all NHS patients. Similar products currently cost people purchasing privately around £2.000.The RNID described the announcement as brilliant news and emphasised that digital hearing aids offer patients a 40 per cent. improvement in hearing and an improved quality of life.Unless the Minister intervenes, digital hearing aids will only be available to my constituents by April 2005 if they applied in 2002. Does she think that that was what the then Secretary of State had in mind when he issued that press release on 6 February 2003? We must ensure that the reality is changed to match the rhetoric, otherwise the headline "Digital Hearing Aids available to all by April 2005" will remain a cruel deception and an indictment of this Government's integrity.
§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)I congratulate the hon. Member for Christchurch (Mr. Chope) on securing today's debate. I know that he has shown a great deal of interest in this important topic, and the Government share that interest. We are investing £94 million in audiology services in this financial year and the financial year 2004–05, in addition to more than –30 million that has already been invested and that will help us to ensure that by March 2005—as he remarked—every audiology department in England will routinely fit digital hearing aids as part of a modernised audiology service.
The hon. Gentleman raised some important issues, and I hope to put them into the context of the situation in England. The progress on modernisation of hearing aid services is good news for everyone with hearing loss. That is something that will affect most of us as we grow older—if it has not already done so. I am pleased to be able to say that to date more than 140 NHS audiology services have been, or are in the process of being, modernised. Fewer than one third of the services in England still need to be modernised and we are on target to deliver fully modernised audiology services in the whole of England by March 2005. Therefore, I hope the hon. Gentleman will accept that we have a national interest in the matter. He questioned that earlier.
§ Mr. ChopeHow is it that the Minister's Department does not have a list of all the audiology departments in the NHS?
§ Miss JohnsonI do not have the details of the answer to that question, but I can tell the hon. Gentleman that 70WH the arrangements on this matter are being rolled out through a contract with the RNID, as he knows. We are working with it closely.
Modernisation of hearing aid services is an NHS success story—both for services and for patients, who are getting a better service. Let us not forget that providing an aid is not a simple process. The hon. Gentleman did not talk much about that process, but I think it is worth while bearing it in mind. A first visit in that process involves the following: a hearing test; talking to the person about hearing in everyday situations to help to decide on the appropriate aid; taking a mould of the ear; and discussing attitudes to using an aid. Later, there is a visit for fitting the aid and a further one to check that all is well and to provide training, if necessary, in the use of the aid.
In some respects modernisation makes services a victim of their own success. In areas where digital aids are already available, an increase in demand has often been noted. That, together with the increased time that it takes to assess for arid to train in the use of digital aids, puts pressure on the waiting times. As I have outlined, this is not just about giving a patient a digital hearing aid and hoping for the best. The audiologist needs to spend more time with the patient to ensure that the aid is fitted and programmed properly to meet that particular patient's needs. Therefore, we have been considering ways to increase the capacity in audiology services. I should like to talk about two of those.
The first is the "Hearing Direct" pilot, a partnership with the high street suppliers, Ultravox and Ormerod. "Hearing Direct" is a way to reduce waiting times in and pressure on audiology departments. It is being piloted at four sites throughout the country—in Chester, Exeter, Leicester and Cambridge. Under that scheme, people can use a telephone information line that gives details of local services. Patients receive a telephone call eight to 12 weeks after the fitting to assess their progress and decide whether they need another visit to the audiologist.
The national framework agreement awarded to David Ormerod hearing centres and Ultravox Holdings plc in October 2003 enables them to provide a service as an extension of the modernised NHS service. I emphasise the fact that the NHS remains responsible for the patient's care. So far that agreement involves sites in Shrewsbury, Leeds, Bradford, Bath, east Cheshire and Bournemouth. That partnership is being rolled out nationally and all modernised sites have been invited to apply for funding to implement it.
In terms of capacity, it is important that we recognise that not everyone in England is yet able to access a modernised service and there are, in certain places, pressures on services. Those pressures can best be reduced by capacity-building initiatives, such as those that I have already mentioned. In the longer term, we are addressing the recognised shortage of audiologists by establishing new degree courses.
Perhaps I should now deal with the hon. Gentleman's constituency. Waiting times for hearing aids in East Dorset have historically been longer than anyone would wish, but steps are in place to reduce them. East Dorset was the recipient of one of the second wave modernising hearing aid services in 2002–03. It has been involved in the extended learning pilot of the partnership agreement 71WH to provide NHS hearing aid services through a high street hearing aid company with an outlet in Bournemouth. Some 300 patients in East Dorset are currently being seen as part of the extended pilot. We expect a further 700 patients to be seen by March this year.
I anticipate that if a service supplying analogue aids to a small number of patients via a GP's surgery wishes to be able to prescribe digital aids, that would be a matter for the surgery and the local primary care trust. There are principles that I would expect the primary care trust to apply when considering whether to support such a development, including whether the service meets the same standards as the mainstream NHS audiology services, whether it unfairly advantages some patients over others, and whether it provides value for money.
The situation in Bournemouth is causing concern, particularly for the hon. Gentleman. I was interested in his remarks on measuring and controlling things. On the one hand he seemed to say that targets are a good idea, but on the other he suggested that we should not have them, and that we are always being told that we have too many targets. However, I think I heard him suggest another target.
§ Mr. ChopeI drew to the Minister's attention a specific recommendation from the Audit Commission in 2000 that her Department should collect data to inform itself about the state of audiology services. It is obvious from her weak response to the debate that she has manifestly failed to do that.
§ Miss JohnsonThe hon. Gentleman's remarks lead me nicely into my second point on targets. The hon. Gentleman will, on other occasions, say that there is too much bureaucracy and too many demands on people to fill in forms. The only way in which information can be collated is if it is collected locally and sent to the centre. The hon. Gentleman and his party spend much time grossly exaggerating the number of administrators in the NHS, while taking us to task for so-called bureaucracy and administration costs. However, he is again proposing another area in which we have more administration.
The Bournemouth teaching primary care trust is concerned about the unacceptably long waiting times for audiology and is preparing an action plan to reduce those, which will include the following measures: it will ensure that guidelines are serving the modern hearing aid services appropriately and making good sense in their application; it will consider ways to minimise the patient journey time for experienced users in discussion with staff and users; it will continue with its existing programme of overtime working; and it will consider pursuing further the use of public-private partnership initiative action to address the shortfalls in the area.
As I said, there is a history of problems. If we consider the overall success nationally, I remind the hon. Gentleman that more than 140 sites and more than two thirds of NHS audiology departments in England have already been modernised or are in the process of being modernised. That is in distinct contrast to four years ago, when the NHS used 1970s technology to fit 72WH analogue hearing aids, many of which remained unused. The Department of Health had to intervene to help trusts bring audiology services up to date, which is another clear indication that we accept our national responsibilities while making it very clear through the shifting of the balance of power programme that the responsibilities for delivery at local level lie with local commissioners and local deliverers—namely, the PCTs and those who actually deliver the services.
§ Mr. ChopeIs the Minister saying she does not believe that she can do anything to reduce the waiting times? I have already told her that patients will have to wait for between three and four years if they apply today for an assessment.
§ Miss JohnsonIt is clear that the Department monitors the performance of commissioners and providers in the NHS through the strategic health authorities. At SHA level and at the level of commissioners, as I have outlined, action is already being taken to address the shortfalls in the hon. Gentleman's constituency and related areas. The action plan to reduce waiting times, which I outlined a moment ago, is being drawn up on that basis.
We have put measures in place to modernise hearing aid services. By March 2005, every audiology department in England will provide the modernised services. To make that possible, the Government have provided central funding for new equipment and to train staff to use it. As I said, training patients to use the new aids incurs additional time costs. We hope that PCTs throughout the country will continue to commission and provide the excellent service that we know is possible.
It is worth briefly mentioning the price of hearing aids. The hon. Gentleman referred to the then Secretary of State's press notice when the digital hearing service was announced. We have driven a hard bargain to reduce significantly the price of digital hearing aids, so that they are now available to the NHS at highly competitive prices. I am sure that the hon. Gentleman will accept that in the light of the comparison that he mentioned. Those prices helped us to make it possible to spread the benefits of the hearing aids much more widely and quickly. They will also make it easier for PCTs to fund them after March 2005. After that time, I would not expect anyone to receive an analogue hearing aid, except for clinical reasons. It might be worth mentioning that some people hear better with analogue aids than with digital ones. As the hon. Gentleman remarked, it is true that the aids are provided free of charge to patients.
I mentioned the collaboration with the RNID to modernise the services. Through that collaboration, the Department of Health learned many valuable lessons about working with the voluntary sector. It also showed the Department of Health and other Departments a way of finding solutions to other difficult problems. When we set out to modernise audiology, the RNID might have called itself one of our fiercest critics, yet the project has shown that even our critics can help us to improve the things that we do and to move towards providing services that are much more responsive to the needs of consumers.
§ Mr. ChopeI am grateful to the Minister, who has been very generous in giving way. I kept my remarks short partly so that we could have this exchange.
73WH Would the Minister be willing to receive a deputation from the East Dorset audiology centre in my constituency? This is almost a dialogue of the deaf. I keep asking what we are going to do about people who are waiting for between three and four years, and the Minister keeps coming out with a whole load of statistics that have no bearing on the plight of my constituents who are eager to get access to these services. We are talking not only about people who need a hearing aid, but about people who suffer from tinnitus, for example, which is a very disabling condition, as the Minister will know. Would she be willing to experience through a deputation exactly what it is like in east Dorset, and to discuss with local people how the Government and East Dorset might work together to try to achieve a solution that is in the interests of everybody living in the area? Would she also accept that the criticisms that I have voiced are not mine alone? They are shared by the RNID, which is as frustrated as I am on behalf of my constituents. We all want progress.
§ Miss JohnsonIt is not for me to suggest to the hon. Gentleman how he might work with his local services. However, if it were my constituency, I would first address the issues with the primary care trust, looking in detail at its action plan and meeting members of senior management to talk about the issues with them and with users. He might want to pursue that locally. The Under-Secretary of State for Health, my hon. Friend the. Member for South Thanet (Dr. Ladyman), has the most direct responsibility for the service. Local issues can only be addressed locally. Given that the majority of funding is now with the PCTs and that extra money is being rolled out through the modernisation programme to support the development of digital hearing aid services, it is not for us to dictate the detail or to direct how the expenditure is deployed.
§ Mr. ChopeIn that case, will the hon. Lady give some advice in her position as a Minister, albeit not the 74WH Minister with responsibility for audiology? Will she publicly advise all the PCTs that have waiting lists in excess of 18 months that that is totally unacceptable, and tell them that something must be done to reduce them to a reasonable level?
§ Miss JohnsonWe can consider the matter of PCTs with longer waiting lists, but there might be reasons for their being in that position—they might have started from a low base, as was the situation in Dorset, with long waits the norm. There is also the time it will take and the training that personnel will inevitably require in order to implement new services. If the hon. Gentleman has explored all the options locally and believes that there is a role for the Department, I am sure that my colleague will consider carefully any request that he might make for a meeting on such a topic. It is important to recognise that we are not in a position to direct individual PCTs with devolved funding and devolved responsibilities on how best to run their services. Investigating problems locally is the most fruitful way forward—PCTs have both the money and the expertise to decide what to do.
In conclusion, audiology services in the NHS are a success story. We have improved services beyond recognition since the first pilots of digital hearing aids in 20 locations in September 2001. We have initiated degree courses to train new audiologists, we have brought down dramatically the prices of digital hearing aids and we have engaged with the voluntary sector, manufacturers and high street providers. The modernised services that are in place in most of England, and that will cover all of it by March 2005, are good news for everybody with hearing problems. As we get older, it will be good news for all of us.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Four o'clock.