§ Miss Emma Nicholson (Torridge and Devon, West)
I was born deaf and I have been liberated. Most of my hearing comes from the best of modern technology. As a result, I am 95 per cent. as good as any normal hearing person in terms of what I can hear. Sometimes in this place, I am very grateful to be able to miss the last 5 per cent., especially with the insulting things that Opposition Members shrill across at the Prime Minister during Prime Minister's Question Time. But if I look at a speaker, I can understand what is being said, because, alas I retain the facility to lip-read.
I thought that I knew the extent of the problem of deafness. After all, if one is born severely deaf and does not obtain the sort of technology that one needs until the age of 40, one has had personal experience of deafness. But I did not realise the extent of this huge problem until I received a mammoth postbag in the weeks since an excellent article was published in The Daily Telegraph by Emma Burstall. She is a young journalist who knew me from the west country, and she has just come from The Western Morning News. She asked me to explore the topic with her when she heard that I was launching a campaign. Since then, my postbag has been crammed with letters whose poignancy I cannot repeat here.
There are hundreds of people who are deaf in some way or another. There are many different scales of deafness. They have become isolated, and the quality of their lives has been greatly diminished. They have become withdrawn and do not go out. They are still looked upon as freaks or mentally handicapped by the public and even by friends and family. There is still a stigma attached to deafness.
Some hon. Members are old enough to remember a time when children who wore glasses at school were laughed at by other children who called them "four eyes". That is a thing of the past. Because of the provision of spectacles on the high street, it is now normal to have several different pairs of spectacles with different coloured frames, perhaps to match one's dress if one is a woman or one's tie if one is a fashion-conscious man, and to go in and out of opticians' shops freely, without any fear, shame or embarrassment, to purchase the correction that one needs and that modern technology provides for sight that in some way is imperfect.
However, it is a different matter with hearing. What happens when one discovers that one is deaf? The first thing to say is that it takes a little time for one to realise that one is deaf. Most people go deaf in old age. One in three people above the age of 70 has a significant enough hearing loss to need a hearing aid, but that is not all. Many young people go deaf. There is what one might call "self-induced" deafness from going to too many discotheques, from getting too close to the speakers and not turning the sound down. There is also work-induced deafness if one gets too close to a piece of loud machinery. The human ear is sensitive—much more so than the human eye. Hearing loss is easy to acquire.
Mercifully, people who become deaf through my condition—or through the reason that I became deaf—are now very rare. My mother had rubella and luckily we now have vaccinations against it, so that cause of deafness is no longer common. None the less, there are still some things 1300 for which we do not adequately test in the United Kingdom. For example, toxoplasmosis is a blood disorder for which we do not test in pregnancy as I believe we should; it can cause physical defects, including hearing loss.
As one in 10 of the population of the United Kingdom has a significant hearing loss, which could be corrected, it can be seen that this is a large problem.
If one discovers that one is deaf, one goes first to one's doctor. National Health Service practitioners often know little about hearing because the medical profession knows that it cannot do much to correct hearing loss. Very little can be done surgically except in rare instances. Nonetheless, the filter that has been set up to enable one to achieve one's goal, which is to have one's hearing corrected, is a series of fine screens, which are so effective that few people emerge at the far end having achieved their goal.
I shall take my area—the south-west—as an example. I represent a constituency with 92 villages, 35 hamlets and five market towns. It is the most glorious part of the United Kingdom and is spread over 1,000 square miles. Because it is so beautiful, many elderly people retire to our area, and because it is so lovely, mercifully, people live for a long time. Therefore, we have a well above average age profile in our population and a low pay-out of child benefit.
The hospitals to which such people must go to get their first appointment with an ear, nose and throat surgeon—that is the second hurdle that one must face—are far away geographically. It could take somebody living in the village where I live two and a half hours to get to Barnstaple. My constituents are unlikely to have transport—we are not a rich area—so they will use the hospital car service. Marvellous though it is, it is mainly a volunteer service and sometimes it forgets to come or it may be late.
The hospital car service was late in calling for the lady who lives with me. As I was up in Westminster I could not take her and she cannot walk. She was going for hydrotherapy. When, eventually, after two and a half hours, they reached Barnstaple, the appointment had evaporated. Other people in different villages may be nearer Plymouth, which can be just as difficult to get to. or Exeter, which is the third referral point for ENT surgeons and consultants.
ENT consultants are busy professionals with lengthy waiting lists. In Plymouth, for example, the waiting time—this is no fault of the ENT consultant—is over 18 months. I have two constituents aged 83 and 85 respectively who have waited for well over 18 months to get on that step of this Jacob's ladder to heaven. They still have not seen him, and the consultant can offer them no date. I hope they will not be dead by the time they get an appointment.
Once they have an appointment, it is 99.9 per cent. certain that the consultant will not be able to do anything for them, because virtually all hearing defects are inoperable. Few people qualify for Cochlear ear implants, which are new and difficult and can cause problems. So, generally speaking, the consultant refers one to the clinic in the hospital which deals with hearing aids.
As a hearing aid user, I am aware of how many fittings one may need to make the aid work for oneself. The first one selected may not be the most suitable. If that happens, it will not be the fault of the dispenser, and I pay tribute 1301 to the excellence of the audiology departments in hospitals. Their staff are superb but, alas, they are gravely handicapped in what they can offer the patient.
The NHS hearing aid provision comprises only one type of aid. I sometimes wonder whether the NHS has noticed that God has given us two ears. Balance is best achieved by both ears hearing equally, and the provision of hearing aids is designed to correct imbalances in hearing. Often when one goes deaf the two ears do not age, in hearing terms, at the same rate. Nevertheless, in the NHS it is one only, so if one is lucky enough to get an aid, one emerges unbalanced.
Being unbalanced, one canot tell where the noise is coming from. One is fussed and bothered and must turn round trying to puzzle out whether the noise is coming from behind, from left or right or ahead. We have two ears to act as funnels for the input of noise. Hearing aids are not like spectacles in terms of technical excellence. They will be one day. After all, if we can put men on the moon, why cannot we correct the hearing of those left on earth?
Instead of having spectacles ground to one's prescription so that they exactly match—or as near as science can manage—one's defects, hearing aid provision is similar to buying a dress or a shirt. There are a number of sizes. One chooses the article closest to one's size and has it altered. The hearing aid is altered by the dispenser.
The NHS thinks that we are all fat, medium or thin. On the other hand, Marks and Spencer knows in its wisdom that we range from size 8 to size 24. The NHS thinks that all human beings are one of three stock variations. I have news for the NHS. That is not the case. If one goes to a private hearing aid dispenser one can choose from perhaps 250 variations of aid.
One is given an aid under the NHS and it does not fit one's hearing. Worse still, it may hurt. Hearing loss occurs at different levels. One may have lost hearing at the lower level, affecting the lower range of hearing. The tone control on the NHS hearing aid can be adjusted to help that lower tone. It cannot be adjusted to help the top range, and one may have perfect hearing at the top. That means that the hearing aid will amplify until perhaps it hurts at the higher level of noise.
That does not happen when one goes to a private dispenser, where one has a choice of 250 variations, the chosen one then being modified to suit one's needs. The modification of hearing aids is the key mechanism in creating the perfect answer. I have the perfect answer, and I know how fortunate I am that, although I was born with this boring handicap, which I did not regard as a handicap, I am perfectly all right. But most elderly people I meet are not perfectly all right because they have to go back to the hospital time and again for fittings to adjust a wretched device which ultimately does not help them. That is why at least one in three hearing aids lives in the top right hand drawer of somebody's dressing table and the drawer is never opened.
What is the answer? I offer several solutions. The aim must be to make it as easy, simple and socially acceptable to get a hearing aid as it is to buy a pair of glasses or a tin of baked beans. A hearing aid should be a normal commodity which is bought and sold so that no one is ashamed or embarrassed, and people would put all their energies not into deflecting public criticism or family 1302 ostracism, but into the effort needed between the patient and the dispenser to achieve the best result. Not all people with hearing loss are as lucky as I am in terms of near-full correction being available practically anywhere. Most people have to seek the best possible correction while the technologists create ever better hearing aids.
I seek the provision of hearing aids on the high street with a voucher system because it is important that patients are referred by a doctor. It is crucial to see the doctor, because people go to hearing aid dispensers with conditions that have nothing to do with deafness. For example, if tinnitus—a horrible buzzing in the ears—is a new condition, it is conceivable that it is nothing to do with hearing but is an acoustic neuroma, a tumour on the auditory nerve. To leave that alone would lead to real trouble. The onset of deafness definitely needs a medical examination. If one's ears are infected, one needs antibiotics, not a hearing aid; vertigo could be the onset of Meniere's disease, so a private dispenser must have a code of practice by which he refers a patient to the doctor before he starts his work.
Hearing aids should be available on the high street, and once a doctor has referred someone to a hearing aid dispenser he should give him a voucher to buy the best possible aid available throughout the full gamut of hearing aids.
The production cost of a National Health Service hearing aid is approximately £21.50, or £23 for the better variant. But private aids are horrifically expensive. Mine is not, as I go to someone of integrity, but people have written to me that they have spent £2,000 on useless aids, nearly always because they have been sold them on the doorstep. I would outlaw doorstep selling, with no further ado. It is a dreadful way of providing a health care product. Elderly people are vulnerable at home. I have had people knocking on my door trying to sell me hearing aids. It is a disgraceful state of affairs and it is sad that companies indulge in such practices, but they do so because the number of their clients is so small. Yet the volume of people needing hearing aids is vast.
If there were hearing aid shops on the high streets as there are opticians' shops, and people had vouchers, they could spend that money as they wished on the variant that suited them best, with the doctor's chit, to prove that they needed an aid in the first place. Children under 16 should go to hospital. We must continue that facility. Perhaps the disabled need home visits, but otherwise the High street is the place.
Furthermore, I would abolish the Hearing Aid Council which reports to the Department of Trade and Industry on a matter of health. It is a most peculiar body and is oddly constructed. That is not its fault. It was set up by a Government. Manufacturers and those who are meant to represent users sit on it. It is a hybrid, a mule, and can produce no fertile offspring. There should be a council, but for quality control, reporting to the Minister for Health. The hearing aid industry which produces aids should have its trade association. When a farmer buys a tractor, he does not expect there to be a tractor council comprising all those who build tractors and farmers who drive them, working out whether they have the best mechanism for ploughing the land. Other reforms could also be introduced. That is the substance of my plea to the Minister today.
Much marvellous work is done for the blind—so much so that Guide Dogs for the Blind has £80 million per 1303 annum in income. Hearing Dogs for the Deaf does not have a fraction of that income, yet the need is as great. There is a huge submerged audience. I am proud to have been able to articulate their deprivation in the House. I call on the Minister to comit himself to investigating with his usual penetrating thoroughness and vision this social scandal. Perhaps he should set up a working party, but let it be time-limited. The problem has been invisible on the agendas of Governments for too long.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)
I congratulate my hon. Friend the Member for Torridge and Devon, West (Miss Nicholson) on an impressive and persuasive speech. She and I have been able to hear each other during the debate, which is not always the case—certainly at certain times of the proceedings in this honourable House.
Perhaps it is not untimely or inappropriate to pay tribute to those who work in the House operating our effective system of microphones and loudspeakers. Many who listen to our proceedings do not know that the microphone is switched on immediately above the hon. Member who is speaking. Hon. Members like me, who do not have as brilliant a range of hearing as our colleagues, find the loudspeakers immensely helpful. Frequently I have been saved from embarrassment when being asked an oral question which I cannot hear by catching the last phrases of the question from the loudpseaker on the back of the Bench.
My hon. Friend and I met recently at the Department of Health to discuss this matter. Today she made six major points. I followed her speech with great care and I agree with her analysis. She talked about the social stigma and misunderstanding about deafness. She said that it was a widespread disability. She has that disability and other hon. Members and I have members of our family with that disability.
My hon. Friend spoke about the National Health Service procedures which involve waiting lists and distances to travel. She talked about the importance of having a range of different appliances available and the greater choice in the private sector. She outlined a solution, which is liberation and transferring the service largely to the high street through reference by general practitioners. She talked about bad selling practice.
To a certain extent, my hon. Friend is pushing at an open door. We have unlocked it and our hand is on the handle. I am sure that my hon. Friend will find that the Government—obviously, I speak particularly for the Department of Health—are sympathetic to her analysis. In the coming months we must work on a sensible set of reforms, which commend themselves to all those who work in the Health Service and, above all, meet patient needs.
My hon. Friend spoke without notes, with conviction and clarity. I am not so fortunate. The disciplines of office, my lack of eloquence and my comparative lack of experience in this matter dictate that, for the remaining minutes of this debate, I shall refer to my notes more copiously than my hon. Friend.
I shall commence by explaining how the NHS service operates. When people realise that there is something wrong with their hearing, their first step should be to consult their general practitioner. If, in the opinion of the 1304 GP, further advice or treatment is necessary the patient will usually be referred to a hospital. It is normal practice for a hospital doctor to examine the patient and, where this is appropriate, to refer the patient to a hearing aid centre, to be fitted with the correct hearing aid. In a significant number of cases the person referred for a hearing aid will also require specialist medical attention.
Hearing aids in the NHS are issued free on loan. Mersey regional health authority, as a national centre of responsibility, procures the aids, stores them at Runcorn and distributes them to hearing aid centres throughout the country on demand. I understand that around 470,000 hearing aids are issued each year to NHS patients in England and Wales.
A wide range of hearing aids are available under NHS arrangements and they are mainly worn behind the ear. Some are high-powered models. Most patients' needs can be met from the NHS range. I accept, however, that inevitably, the range of hearing aids is not as extensive as can be obtained in the private sector. Hon. Members will recall that that was the case when spectacles were manufactured by the NHS.
When new users are issued with hearing aids, audiology technicians usually provide advice and information on how to use and maintain them. They also provide all new users with a copy of the Department's booklet which explains how to use a hearing aid. Efficient follow-up after issue of a hearing aid is essential and that usually takes place at a hearing aid centre or involves a hearing therapist, where one is in post. The rehabilitation of people with hearing loss is not just a matter of providing a hearing aid. It can require time and special skills.
I am aware that there are long waiting times and lists to see consultants and to have hearing aids fitted in some districts, although not in all. I appreciate that there are significant waiting times in my hon. Friend's constituency. In many districts efforts are made to prioritise patients and in several general practitioners can refer patients direct to hearing aid centres. Despite those practices, I know that many people are dissatisfied with the present arrangements and would welcome improvements.
The main thrust of the Fair Hearing Campaign launched by the Royal National Institute of the Deaf in November was that adult hearing aid services should he transferred from hospitals to health centres or group practices. Children would still be referred to a hospital ear, nose and throat department, but only those adults requiring specialist treatment would be referred there. The dispensing of hearing aids would be done by a "community dispenser", who might be employed by the district health authority, general practitioners or a private company contracted by general practitioners.
Since November, those ideas have been discussed with the RNID and others involved. I must say that not all are content with what the RNID has proposed. For example, the British Association of the Hard of Hearing and the British Association of Audiology Technicians have different views. My hon. Friend has a more radical view than the RNID.
The British Association of the Hard of Hearing welcomed the fact that the whole question of hearing aid provision had been brought into the arena for discussion. It agreed, in principle, that a community-based audiology service would be a good step forward, but it is unhappy 1305 about the detail of the RNID proposals and feels that the existing NHS hearing aid service as a whole should be reshaped, rather than creating a completely new service.
The British Association of Audiology Technicians has submitted alternative proposals to my Department. It proposes a total review of the audiology services within the existing NHS system. Such a review would cover a number of issues, including staffing levels, salaries, career prospects, working conditions and funding. The BAAT also wants to retain existing audiology departments within district general hospitals, improve audiology technicians' pay and conditions of service, accelerate referral procedures and expand the NHS range of hearing aids. There are clearly a lot of important issues for consideration in each of those packages of proposals.
I stress at this point that I am talking about the provision of hearing aids for adults. I agree with my hon. Friend that the present procedures for referring children to consultants in hospitals must be right. Most people—including the Royal National Institute for the Deaf—agree that there should be no change in the procedures for the referral of children. I have explained that the NHS range of hearing aids should meet most people's needs and that special arrangements can be made for the others. Perhaps I should add that the NHS range of hearing aids is kept under constant review by a commodity advisory group advising Mersey regional health authority. The Department of Health is represented on that group. However, of course, within the constraints of the present system of procurement and distribution, my hon. Friend's criticism of the range of choice of products is accepted and understood.
I know that a number of organisations, including the Royal National Institute for the Deaf, have expressed concern about dispensers calling at the homes of potential purchasers. The Hearing Aid Council's own code of conduct rules out an unsolicited call and the Doorstep Selling Regulations which came into force on 1 July 1988 provide for a seven-day cooling-off period during which consumers have the right to cancel a contract entered into during an unsolicited visit by a trader to their home or place of work.
The Hearing Aid Council's code requires the consumer to send back a card declining a visit rather than seeking one. I am aware that this system has been the subject of particular criticism by the RNID, and no doubt the Hearing Aid Council will be considering the matter.
The private sector sells about 80,000 hearing aids a year. The Hearing Aid Council receives about 70 complaints a year, and I understand that the RNID has received 260 in the past four months. It is important that concerns of customers should be communicated to the Hearing Aid Council, so that the extent of any problems can be objectively assessed. The Government believe that home visits do have a part to play. They provide a service to some of the hearing-impaired, particularly the elderly and infirmed. Such visits should be conducted to the highest ethical standards. The House will have noted my hon. Friend's comments about practices in that area.
1306 There is some disagreement among those who wish to see radical changes about how closely the fitting of hearing aids can be compared to the supply of spectacles. I am aware that my hon. Friend, for example, sees a direct comparison between the supply of spectacles and hearing aids, while the organisation behind the current Fair Hearing Campaign, the Royal National Institute for the Deaf, has emphasised some of the differences. Corrective lenses can return sight to near-normal, but a scientific evaluation of hearing is not sufficient to indicate the likely benefit to be gained from a hearing aid. With spectacles one immediately sees more clearly; with a hearing aid sounds are louder but, especially for speech, not necessarily easier to understand.
Subject to cosmetic considerations, people can take immediately to glasses, but it takes time and help to get used to a hearing aid. There are also differences in costs —private hearing aids can cost upwards of £400—and in the typical user, as most hearing-impaired people are elderly.
We are grateful to my hon. Friend, to the Royal National Institute for the Deaf, and to all the other hon. Members and interested organisations for bringing these important issues to public attention. We are also grateful to all the organisations who have approached the Department about this for the concerned and constructive way in which they have taken part in discussions, and retained an open mind. We take their concerns about the present service—and those of my hon. Friend—very seriously.
This short debate has not been able to do justice to the complex issues involved, both for the private sector and for the National Health Service. I must emphasise to hon. Members that it will take time to consider them all, in the context of the important reforms which have recently been announced for the NHS.
I can tell the House, however, that I shall be visiting the chairman of the Mersey regional health authority, Sir Donald Wilson, on 3 April—as my hon. Friend knows, that authority is the centre of responsibility for the procurement and distribution of hearing aids—and I shall be raising those important issues with him. Before I meet him, I shall send him a copy of the Official Report of this debate. I am grateful to his authority for its considerable contribution to forward thinking about greater effectiveness in meeting the needs of all patients who require a hearing aid. I will also convey the feelings of the House on this matter to my right hon. and hon. Friends the Secretary of State for Health, the Secretary of State for Trade and Industry and the Minister for the Disabled.
My hon. Friend has asked for a working party. We have not one but several working parties already addressing some of the issues to which she has referred. This is an extremely important matter and, as I have said, we have sympathy with some of the arguments put by my hon. Friend and other hon. Members. I shall consult my colleagues and write to my hon. Friend concerning any issues that arise from my meeting with Sir Donald Wilson. I can assure my hon. Friend that our consideration of the case for reform will continue in earnest.