§ Siobhain McDonagh (Mitcham and Morden)
I am grateful to have secured this debate on universal provision of al hearing aid technology throughout the national health service. This is something of a departure for me, as I normally focus on quality-of-life issues such as graffiti and abandoned cars, but given the proven benefits that al technology can bring to many hearing aid users, the need to make that technology available universally amounts to a quality-of-life issue for deaf and hard of hearing people.
My decision to table early-day motion 317 and to apply for this debate was prompted by the many letters and cards that I received—as, I am sure, all other Members of Parliament did—from constituents who are hearing impaired and rightly concerned about the fact that fewer than 5 per cent. of people who need a hearing aid are in a position to take advantage of al hearing aid technology through the NHS.
I recall the words of the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), when he was the Minister with responsibility for audiology services. He said that the Government wereabsolutely committed to ensuring that people who need audiology services from the NHS will get a first-class service. Nothing else will do."—[Official Report, 2 December 1998; Vol. 321, c. 854.]Those were welcome words indeed. He was responding to a debate initiated by the hon. Member for Richmond Park (Dr. Tonge) the last time the subject of audiology services was debated in the House. The Government's aspiration was a noble one, and it remains equally important that it becomes a reality today, three years later. There are 8.7 million people in the United Kingdom who are deaf or hard of hearing and of those 2 million have a hearing aid. According to the Medical Research Council a further 3 million would benefit from one.
Those statistics are even more striking when one considers that the most common cause of deafness is the wear and tear that come to us all with age, and that three quarters of people with hearing loss are over 60. However, we should not forget that 13 children in every 10,000 are born deaf or become deaf when they are very young. If the mark of a civilised society is how well it treats its very young and very old, providing the best possible audiology service must be a crucial part of that.
I am acutely aware of the huge financial demands on every area of the health service, but I am pleased that. three years after my right hon. Friend made the remarks that I quoted, the Government have made a good start in transforming aspiration into reality in providing al hearing aids. Under the stewardship of my right hon. Friend and, since the general election, my honourable and good friend the Minister of State, Department of Health, thousands of people now use digital hearing aids—the latest and most beneficial technology for those who are deaf or hard of hearing.
In partnership with the Royal National Institute for Deaf People, 20 NHS trusts were chosen as first-wave sites at which audiology departments were to be modernised and where cutting-edge al hearing aids 129WH were to be fitted to patients. Those first-.wave sites had funding of £11 million earmarked for 2000–02 and their success was to be evaluated by Professor Adrian Davis of the Medical Research Council's Institute for Hearing Research. I understand that the results so far have been very positive. More than 10,500 aids had been fitted and almost 13,000 people assessed on the NHS by the end of September 2001, 12 months after the project was set up.
Preliminary evaluation results look good with respect to hearing aid use and benefit, compared with analogue aids. People use al aids more than they used the old type of NHS aids and are finding them much more helpful. Responses from RNID members bear that out. For instance, Sarah Maynard from Hammersmith told the RNID last week that using a al hearing aidhad brought tears to my eyes",so great was the improvement to her hearing. Alex Bevis, from Northwich in Cheshire, who has recently started to use a al hearing aid, e-mailed the RNID recently to say:It's only now that I realise just how isolated and introspective I had become.Professor Michael Krom, an environmental scientist at the university of Leeds, wrote to RNID:I know from first hand how such hearing aids can transform one's existence from essentially a person with a severe disability to one with a problem but one which can be lived with.
The benefits of al hearing aids cannot be overstated, but the palpable frustration for many people who would dearly love an opportunity to take advantage of the new technology through the NHS is that there are still only 20 sites operating in England. That means that fewer than 5 per cent. of those who will be supplied with an NHS hearing aid this year will have a al one. The down side of the old analogue aids is thrown into even sharper relief with the advent of al aids. As the Audit Commission report, "Fully Equipped", of March 2000 puts it:Reports suggest that a third of [analogue] hearing aids are infrequently or never used because of the poor quality of aids and the advice given. This is due to a combination of poor technology, rushed fittings, patchy fitting skills and inadequate guidance and support for hearing aid users. This represents a waste of money, as well as excluding deaf or hard-of-hearing people from society.The report goes on to say that, conversely, al hearing aidsdeliver superior performance, particularly in eliminating background noise; and can be programmed to meet individuals' specific needs. Clinical trials have found that users with digital aids increase their use of the aid (from an average of 6…to 11 hours per day)".
I speak on behalf of the deaf and hard of hearing people of Mitcham and Morden, and, indeed, their families—including my mum, if that is not an unparliamentary term—when I say that they would welcome a commitment to national roll-out as soon as possible, so that the wonderful progress made in the past 14 months will not be allowed to slip in the light of the other financial imperatives faced by the NHS.
There are four reasons why that commitment should be made. First, the quality of life of 2 million people would be dramatically improved. For a small amount of money per person—the equivalent of less than one night's stay in a hospital or one week's stay in a residential home—the national roll-out of digital 130WH hearing aids would offer each person huge benefits. It is difficult to exaggerate just how wasteful the current system is. It is not merely that people are given hearing aids that are inadequate for their needs; often, their current NHS hearing aids are simply not being used. That is a serious waste of public money. It is a false economy in the extreme to provide people with cheap analogue hearing aids if only two thirds are used properly and one third—again, my mother fits into this category—are never used at all. Few, if any, other policies would bring such huge gains to so many at such little cost.
Secondly, with improved hearing people would be able to live fuller lives and would be rescued from the isolation, lack of confidence and reduced communication that deafness can bring. In addition, for those of working age the ability to remain in work would be greatly increased. Although roll-out would involve increased expenditure, in the long run it would lead to savings for the health service and for Government Departments, as everyone knows. As the Audit Commission points out, the introduction of al aids, which can be programmed and adjusted according to the changing needs of users, offers potential economies by reducing the cost of replacements. Furthermore, deafness and the isolation that follows can be very expensive in terms of the effect on physical and mental well-being. al hearing aids extend independent living. The more people can look after themselves, the less of a burden they are likely to be on the public purse.
Thirdly, national roll-out would offer an excellent example of the Government's commitment to modernising the NHS. Audiology services have hardly changed in 30 years. Addressing that long-term neglect and modernising the entire service in the next two years would be an achievement of huge worth, and would show that the NHS can be improved.
Finally, as I have said, the vast majority of deaf and hard of hearing people are elderly. The modernisation of audiology services would be another clear sign of the Government's commitment to pensioners. Indeed, as the Audit Commission says:Nowhere is the cost versus quality debate in the provision of equipment for older or disabled people better illustrated than by reference to hearing aids.Digital hearing aids would help many older workers to hold down their jobs, and would tackle age discrimination in the workplace. Given that job retention for men and women in their late 50s and early 60s is an important objective, there is a clear and obvious benefit. Providing al hearing aids is the right thing to do and makes sound economic sense.
The alternative would be to allow the NHS to continue to supply analogue aids. As a result, more and more people would be forced to purchase al aids privately, and even to travel abroad to do so. A privately purchased al hearing aid can cost up to £2,500, but each al aid costs the NHS only £150. Indeed, as the largest purchaser of hearing aids in the world, the NHS occupies a strong position. It can secure value for money by legitimately driving prices down: the more aids purchased, the more prices would be reduced.
The Government have already committed an extra £25 million for national roll-out from 2003–04. That is excellent news, but leaves some questions unanswered. 131WH First, the Minister will be aware of the worrying anomaly in funding arrangements. As things stand, the £11 million for 2000–02 will run out in five months, but the £25 million will not come on stream until April 2003. There is, therefore, a 12-month gap in the funding of the first-wave sites. Can the Minister clarify and address that situation? At the very least, can she tell us that a further 12 months' funding for the first-wave sites is guaranteed? Given that we are only five months away from the money drying up, an announcement on that would be helpful.
The Government surely do not want to see the 20 first-wave sites taking several steps backwards, and returning to supplying the old analogue aids. Aside from the demoralising effect on staff in audiology departments, the Minister can imagine the sense of powerless desperation that would be felt by patients who have been waiting for such a long time, or by those who have so far been provided with the best possible after care and would not get the same standard after next April.
Secondly, we have had no indication of the detailed timetable for national roll-out. I should be delighted if the Minister could tell us when an announcement was likely. Thirdly, can she confirm that, if national roll-out goes ahead, a full £25 million will be spent and not something up to that amount? Can she also explain how the figure of £25 million was originally estimated and whether she believes that it will cover the cost of the universal roll-out across England?
Will the Minister elaborate on the extent of the private sector's possible involvement in national rollout, a subject she has mentioned in recent replies to constituents and in her speech to the Royal National Institute for Deaf People last month?
§ Caroline Flint (Don Valley)
I congratulate my hon. Friend on securing the debate. On the private sector, may I draw to her attention the fact that my high street optician offers free hearing tests? There may be scope for the Minister to look into whether high street opticians could provide hearing expertise so that people can kill two birds with one stone—getting their eyes and hearing tested at the same time.
§ Siobhain McDonagh
As always, my hon. Friend has an eminently modern and fresh way of looking at things.
A recent leaked letter from the head of an audiology department reveals that such departments are under a lot of pressure. The letter urges colleagues who refer people to his service to play down the benefits of al hearing aids, to cope with high demand. No one would deny that the Government have made significant strides in the provision of al hearing aids on the NHS, or that it would be a tragedy for all concerned if that were unable to continue. It is still in the Government's gift to provide a first-class audiology service. For the millions of people whose disability means that they must rely on hearing aids, nothing but a first-class audiology service will do.
§ The Minister of State, Department of Health (Jacqui Smith)
I congratulate my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) on raising 132WH this subject. I know that she takes a keen interest in it, and has ably lobbied on behalf of her constituents and, as she has made clear today, deaf and hard of hearing people across the country. I am pleased that the debate provides me with an opportunity to tell the House about progress in providing al hearing aids on the NHS to people with hearing impairments, and to mention some of the challenges that future developments will pose.
Like my hon. Friend, the Government recognise the importance of providing modern, good-quality and readily accessible services to people who are deaf or hard of hearing. Providing al hearing aids is one part of a wide range of cross-Government initiatives to improve the quality of life of such people—for example, through employment projects as part of the new deal for disabled people, increased access to television via the provision of subtitling, sign language and audio description services and the extra £105 million that is being provided to improve NHS community equipment services by 2004. Those are just a few examples of the wide cross-Government agenda for improving services for people who are deaf or hard of hearing.
My hon. Friend is keen to pursue the issue of al hearing aids. As she said, leading-edge al hearing aids are now available on the NHS for the first time. Equally importantly, they are being provided as part of a modernised service that puts people with hearing impairment at the centre of the service offered by the NHS. We are providing 21st century technology as part of a 21st century service. Just over a year ago, my predecessor, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), announced the modernising hearing aids services project. Currently, 20 NHS trusts routinely fit al hearing aids as part of a pilot project. By the end of October, 13,270 aids had been fitted and 16,178 people had been assessed. By the end of March, we expect that more than 18,000 will have al aids on the NHS.
As my hon. Friend rightly pointed out in her criticism of the more traditional approach to hearing aid provision, what is important is not only the hearing aid itself, but the proper fitting and assessment that goes with it. The patient, not the hearing aid, is at the heart of the fitting process. That is why the modernising hearing aids services project focuses on improving the rehabilitation that is provided as well as introducing new technology hearing aids.
The modernised patient journey—I apologise for the jargon—includes the formal assessment of the patient's hearing, hearing needs and lifestyle. At the initial assessment visit, a profile is used to assess their individual hearing needs and to discover the situations in which it is important for them to hear well. Another questionnaire assesses their attitude, motivation and expectations in relation to the aid. At the fitting, the aid is programmed using a portable computer with the patient's details and aid settings stored on it. The outcome is then evaluated both acoustically, using a probe tube measuring the response in the ear, and subjectively.
Fine tuning of the aid's settings may be performed about two weeks after the fitting, and about three months later the audiologist completes the profile by asking the patient, for each of the named situations, how much they use the aid, how much they benefit, how satisfied they are and how much difficulty they still have. 133WH That allows the audiologist to pick up on any problems and to identify if more help needs to be provided. The process helps to ensure that hearing aids benefit patients and are used to improve their lives, and that we get the very best out of the technology that we provide.
To support the modernisation project, my Department has provided an additional £11 million, put in place value-for-money purchasing contracts for al hearing aids, introduced new patient pathways designed around patients' needs and provided the necessary computer equipment. We have negotiated keen purchasing contracts for the supply of al hearing aids. NHS organisations can purchase them for about £150, which represents a substantial reduction on the commercially available price. I want to make it clear that all NHS trusts, not only the pilot sites, can take advantage of those contracts, provided that staff have the training and experience needed to fit them safely and effectively. Given what I have just said, the important point is that we ensure that people benefit from access to al hearing aids within the context of the whole process.
§ Tim Loughton (East Worthing and Shoreham)
If it is true that al hearing aids are readily available, why are so many people travelling to Denmark to acquire them at half the British price?
§ Jacqui Smith
As I have pointed out, we want to provide the best process on the NHS, as well as the best product, to ensure that those hearing aids are used effectively, and that people get the high-quality staff that they expect and deserve.
The aim of the modernisation project, which, as my hon. Friend said, is being taken forward in partnership with the RNID, is to test the benefits of providing al hearing aids on the NHS as part of a modernised service. I should like to join my hon. Friend in commending the excellent work that the RNID is doing managing the project and applying its experience and expertise. Having heard news of progress, I am aware that hon. Members will want to know—indeed, some have already asked me—when al hearing aids will be more widely available. I appreciate that people want al aids to be available everywhere so that everyone with hearing impairment can benefit. However, for the reasons I have outlined, we must ensure that we make the right hearing aids available. We must have the infrastructure in place to deliver not only hearing aids, but structures that will ensure that those who receive them can obtain the maximum benefit. That is why, as my hon. Friend outlined, we are evaluating the project.
In July 2000, the National Institute for Clinical Excellence issued guidance on hearing aid technology. It said that insufficient evidence was available to properly judge the benefits of al hearing aids. NICE will be revisiting its guidance in the light of the evaluation of the modernisation project, which is being conducted by the Institute of Hearing Research. We need information about the most effective aids for NHS patients, the best ways to supply hearing aids and how a modern hearing aid service can be delivered to NHS patients. Those are all important points that will inform decisions about the benefits of making these changes more widely available and how best to introduce them. It is important that we get this right.
134WH As my hon. Friend pointed out, researchers tell us that, based on small samples, people with al hearing aids report improvements in hearing, and that they are wearing their aids more often, which means that fewer hearing aids are ending up languishing in kitchen drawers. That is encouraging, but the research is based on limited data. Subject to favourable evaluation, we shall make decisions about how best to spread the modernised service throughout the NHS. We have earmarked funds to begin that roll out, and we have said that up to £25 million will be invested by 2003–04, which answers the question raised by my hon. Friend about whether there is a gap in funding. We are considering the detail of spending allocations over the next year and beyond in light of the many competing and important priorities in the NHS, and the evaluation of the project. That will ensure that as we make the service more widely available, we do it in the most effective way for NHS patients.
We are not only putting more money into audiology, we are supporting NHS capacity to deliver change on the ground by boosting the number of skilled audiology staff that we need. We are working in innovative ways to keep waiting lists down. We are working with members of the profession to develop new streamlined degree courses in audiology. We expect, together with modernisation, that that will make audiology a more attractive career option. We are ensuring that existing audiology training courses are maintained, and looking at ways in which additional trainees can come on stream more quickly. The NHS plan sets out an agenda to increase the number of NHS staff in many specialties and professional groups. In the shorter term, we are working creatively on a range of measures to boost capacity, including the action on ENT programme, which is a project to spread good practice, reduce waiting lists and support better and smarter ways of working. We have invested £75 million in the project in 2001–02.
We must also examine, as does the project, the innovative use of skill mixing in audiology departments to make the best use of skills and expertise. I was pleased and interested to hear the comment about the high street from my hon. Friend the Member for Don Valley (Caroline Flint). I cannot comment on the ability of opticians to provide hearing tests, but I assure my hon. Friend that we are testing the pros and cons of involving high street hearing aid dispensers in the provision of NHS services.
§ Caroline Flint
I was not suggesting that an optician would be qualified to test someone's hearing. I was talking about modern access to services. There are common areas in improving people's sight and hearing and the Royal National Institute for the Blind and the RNID might consider how to bring audiology expertise to high street shops so as to provide people with a service for both sight and hearing.
§ Jacqui Smith
My hon. Friend makes an important point about the modernisation of the whole process and the need to consider new ways of delivery so that benefits are spread as broadly as possible. We are considering ways of involving high street hearing aid dispensers in providing NHS services.
135WH In my recent speech to the RNID national conference, I announced that we would test ways of involving the private sector in support of NHS audiology departments and boosting NHS capacity to deliver benefits as quickly as possible to as many people as possible.
§ John Mann (Bassetlaw)
In her research, will my hon. Friend consider the fact that analogue hearing aids are a problem in many Government buildings that were erected during the 1960s, 1970s and 1980s. They are the worst buildings for those with hearing aids because the majority are of metallic construction, which causes a resonance of background noise. Perhaps the research that my hon. Friend is commissioning could pay particular attention to the problems of hearing aid users if the Government do not proceed rapidly on the use of al hearing aids.
§ Jacqui Smith
My hon. Friend makes an important point and I promise to draw it to the attention of the researchers. However, I cannot promise that we shall be able to examine Government buildings in depth.
§ Tim Loughton
Before we get back to blaming Labour Governments for the buildings of the 1960s and 1970s, will the Minister return to the questions asked by the hon. Member for Mitcham and Morden? If the pilot schemes in the 20 areas, including Redditch, the Minister's constituency, are as successful as they appear to be from anecdotal evidence, will she proceed, without delay, to recommend a full roll-out for the 95 per cent. of the population to whom this important technological aid is not available?
§ Jacqui Smith
I have made it clear that the issue involves not just money, but capacity in the NHS and ensuring that we provide the necessary processes. It was this Government who introduced the process for modernisation. We have been responsible for the progress that has been made so far and we are committed to ensuring that, subject to the evaluation, we make available the best possible services to people who are deaf or hard of hearing.
To return to the private sector pilot, I want to make it clear that we are not talking about privatising the NHS hearing aid service. People with hearing difficulties will continue to be able to obtain hearing aids free on the NHS and we are not devaluing the role of NHS audiologists. They are the key to the delivery of modernised services and that is why we are committed to boosting their number and capacity to provide special skills and expertise. To succeed, we must be willing to explore a range of ways in which we can provide people with hearing difficulties with high-tech hearing aids as part of a modernised service. We are fully committed to achieving that aim.
I am pleased to have had the opportunity to give the House a clear demonstration of how the NHS is being modernised. It provides leading-edge al technology, supported by modernised patient pathways resulting in big improvements for people with hearing difficulties. That is part of what we are pledged to deliver and, subject to the evaluation. we are pledged to continue doing so.
§ Question put and agreed to.
§ Adjourned accordingly at Two o'clock.