§ 7.35 p.m.
§ Lord Allen of Abbeydale
My Lords, I beg to move that this Bill be now read a second time.
Mr. Ieuan Wyn Jones, the Member for Ynys Mon, deserves much credit for steering this Bill through another place. I have no hesitation in commending it to your Lordships today.
As I understand it, there are getting on for some 4 million people in this country, including a high proportion of the elderly, who could benefit from the use of a hearing aid. It needs no words of mine to emphasise the sense of loneliness and isolation which deafness can involve. It is to be borne in mind too that hearing aids are not like glasses, which can provide a more or less instant solution. Hearing aids may well need a period of time and experiment before individuals can get used to them to the best advantage.
The Hearing Aid Council Act 1968, which I believe started life as a ten-minute rule Bill, provided for the setting up of a council to secure adequate standards of conduct for those who dispensed hearing aids in the private sector and made it an offence to act as a dispenser unless one was registered with the council. There are now nearly 650 registered dispensers, and some 20 per cent. of all hearing aids dispensed are bought privately.
The great majority of those dispensers operate efficiently and with perfect propriety. However, it is a regrettable fact that some of them give rise to rather too many complaints about, for example, extravagant advertising, high pressure selling, unwanted home visits, over-persistent follow-up and inadequate redress when a hearing aid turns out to be unsatisfactory. Individual cases may well be known to your Lordships. There are certainly some known to me. I have in mind in particular two rather elderly ladies, both of whom live alone and both of whom have spent several hundred pounds on hearing aids which do them no good at all.
Experience has shown that the Hearing Aid Council has insufficient powers to deal with many of those complaints, and it is the purpose of this Bill to put the matter right.
There are four main proposals. First, the council, under powers conferred by the original Act, has drawn up a code of practice which, as the Act requires, has been approved by the Government. But the council has no powers to deal with breaches of that code as such. Under the original Act, its powers are limited to dealing with the consequences of a criminal conviction or with what is judged to be serious misconduct, whereas the code covers a wide range of matters such as advertising, the conditions under which trainees may operate, arrangements for home visits, guarantees, trial periods and so forth. Clause 2 will bring breaches of the code, either as it exists now or as it may be amended in future, within the competence of the council's disciplinary committee.
Secondly, at present the council has at its disposal one sanction only—erasure from the register. It is 228 an extreme power and it is not surprising that it is not often used. I understand that it has been used only once in the last 12 years, and only seven times in the 21 years of the council's existence. Clause 3 makes provision for a wider range of penalties, adding to the power of erasure the power to impose admonition, a monetary penalty or temporary suspension.
Thirdly, Clause 4 empowers the disciplinary committee to order any party to proceedings before it to pay the costs in whole or in part. I think that that provision should be especially useful. Disciplinary hearings have been few in number, but they have tended to be very legalistic, and therefore very expensive, and have taken up a considerable proportion of the council's expenditure.
Fourthly, and finally, the Bill alters the composition of the council. At present, it consists of six representatives of the trade and five consumers and medical or technical experts with a chairman who has only a casting vote. Clause 5 proposes that, in addition to the chairman, there should in future be a membership of 12—four from the trade, four consumers and four medical or technical experts.
I am conscious of two aspects that have given rise to some concern. The first is that the monetary penalty of £1,000 which the disciplinary committee can impose under Clause 3(2) seems to be on the small side. But it can hardly be more than the fine that can be imposed on the unregistered operator. Clause 1 puts that also at £1,000. I believe that the figure is not wildly out of line with that for other professions, but the Minister may have a word to say on that topic.
The other point is that some members of the trade have expressed the fear that the new composition of the council would mean that, in practice, it would be over-weighted in favour of the consumer; but I am sure that the Secretary of State will be alive to the need to secure an adequate representation of impartial and independent members.
This Bill has received wide support. I have received quite a number of notices from noble Lords who would like to support the Bill even though they cannot be here in person this evening. The council will celebrate its 21st birthday later this year. The promise of a new set of powers to make it more effective would be a welcome birthday present. My Lords, I beg to move.
Moved, That the Bill be now read a second time.—(Lord Allen of Abbeydale.)
§ 7.44 p.m.
My Lords, I am delighted to pledge the support of my noble friends on these Benches to the noble Lord and his Bill. Perhaps I should refer to my noble friends who would be on these Benches should the need arise. I am particularly delighted that this Bill, which started life as a Private Member's Bill in another place, should have found so expert and efficient a pilot as the noble Lord, Lord Allen of Abbeydale. I believe that the Bill could not be in safer or more expert hands for its later conduct and I am glad about that.
229 I have a special interest in this Bill because I was the second sponsor of the original Bill which, as the noble Lord rightly said, started as a ten-minute rule Bill introduced by Mr. Laurie Pavitt, MP. I took a great interest in the original Bill and have taken a great interest in the working of the Act ever since.
I should make it quite clear that I believe that, had the provision under the National Health Service—the old hearing aid clinics or audiology clinics; they changed their name at various times—been wholly adequate, the need for recourse to the private sector would have been very much less than it is. The noble Lord who is to reply will remember that there have been many arguments over the years and many times when the number of different hearing aids which were available was varied. There were campaigns with regard to the old hearing aid which was worn on clothing, made a noise and was totally unsuitable for nursing mothers and others. Gradually, there were changes in the National Health Service provision. I should like to say without hesitation that, in many ways and for many people, the National Health Service has wholly effectively provided hearing aids which have been entirely satisfactory for the people who have made use of them.
However, the fact remains that the National Health Service has always lagged behind and has not been at the forefront in accepting the effects of new technology and in making readily and freely available to a wide spectrum of the population the most modern and acceptable hearing aids as they come on to the market. That has in part been the reason why so many people have had recourse to the private sector. Let me say at once that many of the private dispensers—the private hearing aid firms—do admirable work of a high professional quality. I should not like that point to be forgotten. Many of them are very good indeed.
However, the fact also remains that some of those companies are not quite so good. In some cases, their professional standards are not as good as one hopes. That was the main reason why a hearing aid council became necessary. It kept a watchful eye on what was going on and, from time to time, it took action. As the noble Lord, Lord Allen, reminded the House, the disciplinary committee has met only five times since 1966 and, in those 12 years, it has struck off only one dispenser. However, it had great influence because merely striking people off is not the only remedy; its very existence, and the way in which it worked among the profession that provides hearing aids privately, improved professional standards vastly. Some of those standards are very high indeed.
Unfortunately, however, standards are sometimes not as high as they should be. I recently had reason to advise some hearing aid companies close to my own home of other legislation. There is the Department of Trade and Industry's booklet Selling Away From Business Premises—A Trader's Guide to the Consumer Protection (Cancellation of Contracts Concluded away from Business Premises) Regulations 1987. To my certain knowledge, many of those firms were in clear breach of those regulations and did not even know of the existence 230 of the booklet until I passed it to them. There is the caveat emptor principle: but what about the seller? Not only do those regulations confer rights on the purchaser; they confer clear obligations on the seller who has a legal obligation to give written notice of the purchaser's rights when he or she buys goods away from trade premises. Failure to do so is an offence. I think that it came as a bolt from the blue for some of those firms to be made aware of that provision.
However, we are not talking about those regulations; we are talking about other means of supervising what happens. In some cases there is cold calling and doorstep selling. Salesmen, possibly from reputable firms and, quite likely, with good products, call and persuade elderly people that the hearing aid that they can provide is much better than the NHS one that the elderly person possesses. Consequently, there is a great deal of waste and duplication. In my experience in general medical practice, when old people die one finds that they have four or five hearing aids—three National Health Service aids and perhaps two other hearing aids which they have purchased privately, often at great expense. Very often the problem had been that they had never learnt how to use any of those hearing aids properly. They had often been persuaded to buy one which they did not need. That is a practice which we must look at very carefully.
When my mother-in-law died last year at the age of 94 she left behind her four hearing aids, two of which came from the National Health Service and two from private companies. She used none of them properly; rarely in fact did she use any of them. Nonetheless the fact remains that she was very open to being influenced and when someone suggested that she would do much better with one of the private aids which would be totally invisible and which no one would notice, she bought one. She did not need it. We must look carefully at that kind of situation.
I am not talking about professional misconduct. Many hearing aid firms do very good work indeed and some of their audiologists carry out careful examinations of the patients who come to them and make sure that the appliance which they prescribe for that patient is wholly suitable for him. That is fine, except that sometimes they are very expensive and occasionally the patient could have done just as well with a National Health Service hearing aid had he or she bothered to obtain one.
I am grateful to the noble Lord, Lord Allen, for explaining so clearly the purposes of the Bill. In my eyes it has three main purposes. First, it amends the composition of the council so as to achieve a better balance between representatives of the trade and representatives of the consumer, with an independent element, as the noble Lord explained. Secondly, it widens the range of complaints that the council can investigate, and that is important. Thirdly, it widens the range of sanctions that are available to the council to deal with trade malpractice.
I believe that the original Bill was a success and that the existence of the Hearing Aid Council did a great deal to improve professional standards and much to protect many elderly and particularly 231 vulnerable people. The deaf and hard of hearing are vulnerable and the council did a great deal to protect them. But time and experience have shown that more needs to be done. I believe that whatever individual and minor defects this Bill may have—and surely they can be remedied at a later stage—it is a very important step toward that end.
§ 7.50 p.m.
§ Lord Sherfield
My Lords, I rise to intervene in this debate but I should first declare an interest. I am becoming increasingly deaf and therefore dependent on hearing aids. That has led me to pay some attention to this Bill which I might not otherwise have done. I support the objectives of the Bill, which has been so clearly and sympathetically introduced by the noble Lord, Lord Allen of Abbeydale.
I have only one comment to make on it. As the two previous speakers said, the composition of the council has been altered, on what I think is a proposal of the Government, to provide for the increased representation of consumers and technical members, and the industry representation has been reduced. The industry has hitherto provided all the finance for the council and no doubt was ready to do so in view of its strong position on the council; namely, six members out of 12. Now that its representation has been reduced to four out of 13 members, it is still required to foot the entire bill and prima facie that seems inequitable.
When that point was raised during the debates in another place the Government's response was that the industry would indirectly recoup part of the expenditure because any fines levied under the Bill would be paid to the council and that, in large measure, would offset any costs that might be incurred, including any further expenses foreseen as a result of additional proceedings taken in view of the widened provisions of the Bill. The industry would therefore be partially compensated, even if its representatives were unhappy about the decisions of the council.
I may be a little naive, but this seems to be an extraordinary basis on which to finance anything. It is uncertain, unquantifiable in advance and, I should have thought, rather undesirable. I know from experience in other fields that the Government endeavour to make industry foot the bill whenever an opportunity presents itself, even though the purpose is for the public good, as it seems to be in large measure in this case. I hope that the Minister can give a rather better, more convincing and, dare I say, more respectable justification for their position on this Bill than was given in another place.
§ 7.57 p.m.
§ Lord Ennals
My Lords, like other noble Lords I warmly welcome the Bill. I congratulate the noble Lord, Lord Allen, who has done so much over many years for disabled people. I also congratulate Mr. Ieuan Wyn Jones who introduced the Bill in another place. As has been said, it is an important Bill. It is strongly supported by the Royal National Institute 232 for the Deaf as well as by MPs and Peers from all parties, deaf and consumer organisations, organisations for the elderly and parts of the private sector, because it will offer greater consumer protection to a largely elderly group of people who are hard of hearing. I think that the Bill is well thought out and I support it in every respect.
The point made by the noble Lord, Lord Sherfield, is an interesting one. I too shall be interested to hear what the Government have to say, because on that basis it would be more realistic for the Government to foot the Bill when it is for a task that they want to be done. Clearly they will support the Bill because if such a change is made they have to pay nothing. It costs nothing and therefore it can be supported. However, this approach to the problems of the deaf is not adequate. Even this modest Bill can only reach the statute book, as did the original Act, by dint of a Private Member's Bill. Frankly that has been the case for most advances in provision for disabled people for many years.
More serious is the failure to tackle the real problem, which requires resources. That is why I touched upon this issue in what was almost my first sentence. I should like to congratulate the Royal National Institute for the Deaf which has produced a very good study entitled Hearing Aids—The Case for Change. It develops a thorough technique of evaluating present hearing aid services and argues the case for a reorganised system and of course for more resources to be made available. As this report points out, there is much wrong with the system. The present hearing aid services are failing to satisfy many chronic needs. Consumers are not receiving the services that they should receive. There are long waiting lists. The average waiting time for an ENT appointment is 16 weeks and it can take up to two years before one receives an appointment. I have been waiting for 14 weeks so far and I wonder how much longer I shall have to wait. I should like to shorten the time if I can and I may write a letter about it. This is a disturbing situation and it can take a further 14 weeks before a consumer is finally fitted with a hearing aid.
There is also a staffing crisis in the National Health Service. In some parts of the country hearing aid services have virtually collapsed because of such shortages and the problems of recruiting new audiology technicians. The Office of Population Censuses and Surveys in its disability survey identified about a quarter of a million adults who had hearing loss and who were living in communal establishments. Almost without exception hospital departments cannot offer services to those consumers. The RNID also believes that the service is ineffective. As has been said, after receiving a hearing aid, 20 per cent. of consumers do not in fact use it. Studies and pilot projects have confirmed that the use and benefit of hearing aids can be maximised by good advice given on fitting and follow-up visits to deal with any problems that arise; but that cannot always be done by a hospital-based service which is sometimes under strain.
My Lords, perhaps the noble Lord would allow me to intervene for a moment. In 233 the main he has been speaking of the hospital service and hospital waiting lists which are dealt with through ENT clinics. Is it not right that in some areas the general practitioner can refer a patient direct to a hearing aid centre? In other areas, the rules are that they must be referred through the ENT clinic. That position is surely not satisfactory. It would be better if they could all be referred direct by the general practitioner.
§ Lord Ennals
I very much agree. I recognise the strength of the argument, and the problem. Such referral might solve part of the waiting list problem.
I am glad that the Minister who speaks for health is present because these are issues that need to be considered by the Department of Health. There is a certain anomaly about this Bill not being a health Bill. That point was made in another place when the Bill was debated. As we have heard any consumer who buys an aid privately from a dispenser who visits his home is subject to high pressure sales methods. That is undesirable for elderly people.
I have briefly summarised only parts of this document. We have here some very piercing criticisms and positive proposals about how the hearing aid service should be developed. This is a matter to which we should give our attention. I hope that the Minister will do so.
One of the sponsors of the Bill in another place, Miss Emma Nicholson, was very critical of the role of the National Health Service. At col. 1211 of the Official Report in another place on 28th April she said:The National Health Service is still in the age of the dinosaur".I do not know what she meant by "still". It was not in the age of the dinosaur in my time. It has just become a dinosaur in the last decade. She continued:National Health Service dispensers are gravely let down by the paucity of technological development in the hearing aids that they provide. . . . Technical change continues and it outstrips the NHS".The role of the Hearing Aid Council would be less important if a decent service were provided for NHS patients, a point made by the noble Lord, Lord Winstanley.
In a debate in another place on 23rd March, at col 1303 of the Official Report, the Minister, Mr. Forth, was quoted as saying:
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, to meet patient needs".That was said in a debate which had followed many of the recommendations in the report of the Royal National Institute for the Deaf. I do not know whether the Minister can say, having had a word with his friend, whether there is any progress on this review. Is the Department considering it with great care? I certainly agree with a point made in a letter to The Times by the noble Earl, Lord Snowdon, on 16th February. He was talking about unscrupulous high pressure salesmen. He said that he had no objection to companies making profits on something that is not needed—luxuries for able-bodied people—but when it is cashing in on people with disabilities, that is another matter. I take that same view myself.
234 While I absolutely support the Bill as it is presented to the House, and wish to see it achieve rapid progress, I hope that the Department of Health, which has the real responsibility, does not think that it has now solved the problem, because it has not. I hope that we can have an assurance that the recommendations that have been made by the experts—the Royal National Institute for the Deaf—will be very carefully considered. I hope that a Statement will be made which can be debated in both Houses, so that we may eventually undertake some action. I do not wish to underestimate the importance of this Bill but we need to do far more. I hope that we shall hear something about that from the Minister when he replies.
§ 8.5 p.m.
§ Lord Strathclyde
My Lords, I have the honour to speak for the Government in support of this Private Member's Bill. I should like to thank the noble Lord, Lord Allen of Abbeydale, for introducing the Bill to this House so clearly and concisely, and all other noble Lords who took part in the debate for bringing so much expertise to it. In particular the noble Lord, Lord Ennals, brings a great deal of expertise to this debate, having been a Minister of State for Health in the last Labour Government. It is a great pleasure to listen to him. However, I think that he will admit that he raised some issues that were not directly related to this Bill. He will therefore not be surprised if I do not answer all his comments.
The noble Lord, Lord Winstanley, reminded us that the Bill would not be before us today without the efforts of Mr. Laurie Pavitt who introduced the setting up of the Hearing Aid Council in 1968.I was not aware of the noble Lord's interest in the subject. Yet again, we have another expert with whom I have to deal.
The main purpose of the Bill before your Lordships today is to strengthen and improve the Hearing Aid Council Act 1968. The Government support this endeavour and will strive to ensure that the amendment Act is the best possible for all concerned. The private hearing aid industry stands to benefit from greater public confidence in the council's ability to ensure the highest standards of conduct and competence among private dispensers. The hearing impaired stand to gain from improved levels of protection which this Bill seeks to introduce.
It is only right to point out that since the Act was passed in 1968, standards of competence and conduct in the dispensing of private hearing aids have greatly improved. But, two years later, we should be and are looking at a Bill to amend the Act in order to reflect current views and concerns.
Perhaps I may first remind your Lordships of the provisions of the current Hearing Aid Council Act and of the functions of the Hearing Aid Council. It is an independent statutory body which finances itself entirely out of revenue from registration, retention and examination fees. The council has the general function of securing adequate standards of competence and conduct among private hearing aid dispensers. The Act requires all dispensers and employers of dispensers of hearing aids in the private sector to be registered with the council.
235 Some people have expressed surprise that the council is the responsibility of the Secretary of State for Trade and Industry. It has been the responsibility of the Board of Trade and its successors since the Act was passed in 1968 because the Act is concerned with consumer controls and the regulation of trade practices which are essentially trade matters.
The major change to the present Act proposed in this Bill concerns the composition of the Hearing Aid Council. It had become increasingly clear over recent months that the existing composition of six representatives of dispensers and five representatives of the hearing impaired or those with specialised medical and/or audiological technical knowledge plus an independent chairman, no longer had the confidence of the hearing impaired public. The sponsor of the Bill proposed a council consisting of six representatives of dispensers and six representatives of hearing-impaired consumers or those with medical or audiological knowledge plus an independent chairman. The Government had reservations about this proposed composition regarding it as a recipe for confrontation and a formula which was bound to put unreasonable pressure on the chairman. He could be required on a regular basis to exercise his casting vote, running the risk of being seen to be "siding" with one group or the other and jeopardising his independence. It is placing a heavy burden indeed on any chairman to retain this delicate balance while seeming to be impartial and commanding the respect of all members of the council.
The Government therefore tabled an amendment in order that the committee in another place could fully consider the relative merits of two alternative possible compositions of the council. The Government's amendment was approved and now forms Clause 5 of the Bill. It provides for the council to be comprised from 1st January 1990 of four representatives of dispensers, four representatives of hearing-impaired consumers and four with appropriate medical or audiological knowledge plus an independent chairman. We believe that on the basis of this formula the council will be enabled to reach balanced decisions. It also ensures the continuing independent stance of the chairman.
The noble Lord, Lord Allen of Abbeydale, explained each clause in his introduction. I therefore do not propose to do the same. However, perhaps I may deal with some of the issues that were raised during the course of our debate.
The noble Lord, Lord Allen of Abbeydale, asked about penalties. To those who fear that the penalties listed in Clause 3 would not be sufficient, I would stress that there is a need for consistency between this and other similar Acts and the need for some compatibility with the level of criminal fine which can be imposed on an unregistered dispenser which the Bill proposes to set at level 4—that is, £1,000.I would point out also that the disciplinary committee would be empowered to impose one or more of any of the penalties in Clause 3; for example, a fine plus six months' suspension.
Concerning the council itself, the Department of Trade and Industry's present practice is to invite 236 nominations to the membership from a wide range of organisations, and the department will continue to do that. These include bodies representing the interests of the hearing impaired, including the Royal National Institute for the Deaf, the British Association of the Hard of Hearing, the National Deaf Children's Society, the British Association of Teachers of the Deaf, Age Concern and Help The Aged. A number of specialist medical bodies are consulted as well as the main trade associations representing hearing aid dispensers, the Society of Hearing Aid Audiologists and the British Hearing Aid Industry Association.
The Department of Trade and Industry is always happy to add organisations to the consultation list. In addition, it is open to any member of the public with genuine involvement with the dispensing of hearing aids or with the hearing impaired or who has specialised technical knowledge of deafness to make nominations. All nominations are considered on their merits.
The noble Lord, Lord Sherfield, quite rightly asked a question about the funding of the council. He asked me to justify the funding, if I remember, in a more respectable fashion than had been done in another place. I shall try to do that. The important point to realise is that there are precedents for this provided by the Opticians Act 1958. Although the General Optical Council is under the ultimate control of the Privy Council, its constitution, status and function are broadly similar to those of the HAC. The GOC consists of 24 persons, of whom only seven are chosen to represent registered opticians. As with the HAC, they have to pay a fee to be entered on the register.
Furthermore, the existence of the council is in the industry's own interests. It requires dispensers to be registered and to maintain standards which improve the image of the industry as a whole. The level of the annual fee has of course to be approved by the Secretary of State, who also approves the codes of conduct and standards. Therefore he gives full consideration to all the financial implications.
There is nothing in the Bill which would increase costs. Rather, they stand to be reduced in view of an amendment to disciplinary costs. The main area of cost to the council, as far as we can see, is in those disciplinary proceedings. If the industry abides by the Act and the code of conduct, there should not be a significant increase in disciplinary activity. In addition, the government amendment would allow the disciplinary committee to recover costs from a guilty party. Also, fines will go to the council and thus generally tend to reduce registration fees.
Furthermore, the way that the council has been set up, with four representatives of dispensers, four representatives of hearing impaired consumers and four with appropriate medical or audiological knowledge, is, I believe, not necessarily an eight-to-four vote against the industry.
The noble Lord, Lord Ennals, asked about the RNID fair hearing campaign. The RNID's proposals are radical and far reaching. They cut around the present arrangements under both the NHS and the private sector. The Government would not wish their consideration to be constrained by an artificial 237 deadline, but your Lordships may rest assured that they will respond as soon as the proposals have been given the thorough consideration that they merit.
The noble Lord, Lord Winstanley, asked about the Cancellation of Contract Regulations 1987. Of course these apply to unsolicited home visits. The regulations give the consumer the right to cancel the contract within seven days. The Department of Trade and Industry wrote to the Hearing Aid Council drawing its attention to the regulations when they came out. If there are problems, I shall certainly pass them on to my noble friend the Secretary of State and we shall no doubt look into them.
I am pleased to be able to tell your Lordships that the Government are content with the Bill as it has emerged from another place. I commend it to your Lordships' House.
§ 8.14 p.m.
§ Lord Allen of Abbeydale
My Lords, I should just like very briefly to thank all noble Lords who have spoken. I congratulate the noble Lord, Lord Ennals, and to some extent the noble Lord, Lord Winstanley, on their skill in widening the debate on a comparatively modest Bill. I think that the points which they made are certainly worth consideration.
I trust that my noble friend Lord Sherfield is content with the explanation which has been given about the modest registration fee of £66. No doubt he will wish to study the words of the Minister very carefully in Hansard tomorrow. I think that that is all that I wish to say. I trust that the House will give the Bill a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.
§ Moved accordingly, and, on Question, Motion agreed to.
§ [The Sitting was suspended from 8.15 to 8.35 p.m.]