House of Lords Debate
Health: Audiology
8 January 2008
Baroness Howe of Idlicote asked Her Majesty’s Government what progress has been made in implementing the National Audiology Action Plan contained within the Department of Health report, Improving Access to Audiology Services in England; how they intend to ensure that audiology is regarded as a priority area by strategic health authorities and primary care trusts; and what specific role they envisage for the independent sector.
The noble Baroness said: My Lords, I begin by declaring an interest. I have used hearing aids of one kind or another for almost half a century. More recently, I have had the considerable benefit of the new digital aids, in both ears. Put bluntly, because I have been able to afford the independent sector’s excellent audiology services, I am able to remain a fully included Member of your Lordships’ House and the wider community.
My concern is that everyone with hearing needs should receive the same timely service from the NHS. Sadly, that is not the case at present, as capacity in the NHS is not keeping pace with demand. As your Lordships will recall, on 1 March last year, in order to address this problem the Government published their long awaited national audiology action plan. Your Lordships will note that this document was published on the same day that the Minister was due to appear before the House of Commons Health Select Committee, in order to respond to its concerns over audiology services in England. The very fact that that committee launched this inquiry underlines the seriousness of the situation. Yet neither the committee’s report nor the Government’s response, published, respectively, in May and July last year, has yet been debated in either House. Furthermore, most of the representative bodies at the inquiry have expressed their views on that response, and they are all very critical, so today’s debate is both necessary and timely.
There can be no doubt about the scale of the problem which, with our ageing population, is bound to become more pressing. The RNID estimates that 55 per cent of people over 60 are deaf or hard of hearing. In total, over 4 million people in the UK have a hearing difficulty that would be assisted through the use of properly prescribed hearing aids, and it is common ground, which I hope the Minister will confirm, that about 2 million people in need are not yet provided with a hearing aid or aids. So there is clearly a huge task still to be tackled.
Your Lordships will recall how often, in other debates, we all, but especially the Government, have emphasised the need for inclusive social policies. One witness quoted by the RNID, Janine Roebuck, an opera singer, makes very clear just how important that concept is in this context. She says:
“My hearing aids are my lifeline. Long hearing aid waiting times means spending years struggling to hear and battling isolation and depression”.
That is the background to have in mind, as we react to the fact, whatever the long-term need, that as stated by the RNID no less than 250,000 people are currently waiting for a digital hearing aid.
How have the Government reacted? In May 2006, they set a target that by March 2007 no one should have to wait longer than 13 weeks for an audiology assessment—note those words carefully—and that by March of this year no one should be waiting longer than six weeks. However, the most recent figures, for October, show that almost 48,000 people were still waiting more than six weeks for an assessment, and more than 34,000 over 13 weeks. Furthermore, more than 13,000 patients have been waiting longer than a year for an assessment. I stress that these government targets and figures are for waiting times for an assessment only, and certainly not for actually being fitted with a hearing aid. Remarkably, the Government do not publish waiting-time data for what is called “the full patient journey”.
What then is the picture if one takes in that second period between assessment and supply—as clearly one must? Indeed, the Select Committee specifically recommended that. For the past four years the British Society of Hearing Aid Audiologists—BSHAA—has carried out an annual survey of waiting times for precisely that full patient journey from referral to supply. Its results are, therefore, much more meaningful than the Government’s official figures and the findings are even more disturbing. The latest BSHAA survey published last September indicated that while there has been some fall in waiting times in the past year, patients are still having to wait an average of 36 to 38 weeks between referral and the actual fitting, at last, of a digital hearing aid. Moreover—and astonishingly for someone wanting only to upgrade from an analogue to a digital hearing aid—the average waiting time is even longer: between 44 and 47 weeks.
These BSHAA surveys have also highlighted serious regional discrepancies in waiting times. This has recently been underlined by a report from the RNID based upon freedom of information requests, delivered to every PCT, only two months ago. Out of the 100 trusts that have responded, no less than 11 have average waiting times of more than a year from GP referral to fitting of hearing aids. Some have waiting times of more than 18 months. In Kingston-upon-Thames, new adult patients wait an average of two-and-a-half years. Who knows how much worse the figures might be for the 50 or so trusts that have failed to reply to the RNID? What are the Government doing to address this? At one time we thought we knew. In July 2006, the then Minister, the noble Lord, Lord Warner, announced that 1.5 million patient pathways were to be procured from the independent sector at a rate of 300,000 per annum for five years. We have now passed that date and, alas, have seen no evidence of this happening. Instead, strategic health authorities locally have been tasked with filling their capacity gaps with,
“a combination of greater efficiency in existing services where possible, and, where that is insufficient, new capacity”.
So what has happened to the national audiology action plan and why do we have no clear or continuous plan for effective engagement of the independent sector? The modernisation of hearing services—MHAS—project to equip the NHS with facilities to offer digital hearing aids began in 2003. It included a limited independent sector involvement through a PPP. Although only two independent sector companies were involved, no less than 68,600 patients were fitted with a hearing aid through that PPP until it ended last April. More significantly, it was accepted that the companies’ standards in providing fitting and follow-up service matched those of the NHS.
Despite all the current barriers to its involvement, the independent sector is, of its own volition, making a contribution towards alleviating pressures on waiting lists—for example, by helping to test patients’ hearing at their local GP surgery, thus speeding up the initial assessment and referral process. Some PCTs have also involved independent-sector providers in assisting with part of the full patient journey—for example the fitting of an aid and follow-up. But these are piecemeal approaches, wholly dependent on local initiatives and not part of any coherent policy by national government. The independent sector continues to invest in training of hearing aid dispensers who are fully qualified to carry out hearing assessments and fit hearing aids. Yet this significant capacity, a workforce of some 1,400, is virtually ignored in the Government’s calculations. Is it not high time to consider a more direct—indeed, a more actively participant—role for the independent sector?
I invite the Minister and, indeed, the rest of your Lordships to study the evidence given to the Health Select Committee by Specsavers. From that, it is clear that developing a market for directly supplying audiology services financed by the NHS along the lines of the successful optical prescription model would offer the public greatly improved access, choice and quality.
In summary, the Government’s actions do not measure up to the scale of the problem. The Department of Health seems unable to ensure that the NHS works in partnership with the independent sector to develop a sustainable national audiology service. Consequently demand cannot be met and patients continue to suffer. I end by quoting the closing paragraph of the BSHAA report, Suffering in Silence2007, which states:
“BSHAA has for some time said it is puzzled why the Government does not recognise that the independent hearing care sector on the high street has the skill and expertise necessary to help solve the waiting list problem”,
and,
“offer patients real choice; choice of location, choice of time, choice of instrument, choice of dispenser and even choice of how many and which hearing aid they have fitted”.
I am much looking forward to this debate and, in particular, to hearing from the Minister when and how the Government will open the door that will enable us to start proceeding down the road that I have described.
Lord Giddens: My Lords, we owe the noble Baroness, Lady Howe, our plaudits for setting up this debate on a topic that is unjustifiably low-profile in our thinking. It would be hard to dispute that audiology is one of the Cinderella areas of the NHS. This in some part reflects widespread cultural attitudes towards hearing loss in our society. If someone goes blind, it is universally regarded as a tragedy, but even people whose problems are of being very hard of hearing can be regarded with scorn, mirth and derision which is surely inapplicable, given the scale of the issues that we face in this area.
A recent study of the baby boomers generation in the US concluded:
“The reality is that hearing loss has a long way to go before it is considered a legitimate public health issue”.
I would suggest that the same applies in this country, too. That is pretty amazing when one considers the facts. According to the same study, 25 per cent of the baby-boom generation—people between 50 and 60 years old—suffer from serious noise-induced hearing loss, in addition to hearing loss brought about by ageing processes. Some observers in America have spoken of a hearing health epidemic and I do not think that that is an overstatement.
The issue is not just that people can be incapacitated in their everyday lives, but it can also have a significant impact on their work and capability to work. We live in a service-based society in which we spend most of our working days interacting with other people. Many kinds of jobs can be impossible for people who do not get effective assistance in such a situation
The other side of this issue is a tremendous and continuing wave of innovation in hearing-aid technology and, more generally, in technologies linked to those who are either deaf or seriously hearing impaired. At the cutting edge of this technology is nanotechnology; on the commercial market there is already a hearing device available which can be implanted, is invisible to the external observer and has a battery life of some five years. Tremendous technological revolutions are going on.
When I read the Government’s document, Improving Access to Audiology Services in England, and their response to the House of Commons Select Committee report, I felt that I was living in 1948 rather than 2008. I give three reasons for this: one is that digital aids were not introduced into the NHS until 2001, in spite of the fact that they existed for many years previously, although, of course, they were improving radically. That raises the issue of whether what is going on in the intersection between the NHS and the private sector is really at the leading edge of technological developments. Secondly, as the noble Baroness said, no reliable data are collected, or has been collected to date, on the wait between GP referral and treatment. As I understand it, the Government have now committed themselves to collecting that data. That is clearly a serious lapse. Thirdly, as the noble Baroness also said, the survey by the RNID found that many trusts had very long waiting times. This was based on a sample, rather than a universal survey, so to some extent it was guesswork. Like her, I picked up the case of Kingston, where there is a wait of 2.5 years, which translates into 125 weeks.
I have four questions for the Minister, which she might answer directly or subsequently. First, is this figure of 2.5 years for Kingston health trust valid? Is it really true? It seems quite incredible. Secondly, the person choosing open-ear technology today, and who goes privately, can get tested and fitted not only in one day, but within one hour of going to the practitioner. Yet the Government document says proudly that the Norfolk and Norwich University Hospital NHS Trust, using open-fit technology, has seen treatment waiting times drop from 28 weeks to 21 weeks. Could the Minister explain this yawning discrepancy? Thirdly, as the noble Baroness has said, surely there must be must more effective ways of integrating the public and private sectors. She mentioned the case of opticians, where there is indeed very little waiting—where, because of technological innovation, you can get a pair of glasses within an hour. Here again the Government seem to have made only modest progress, especially in relation to the target that was also mentioned. According to the calculations I saw, only 116,000 people have been treated under a PPP arrangement. Fourthly, in his speech the other day, the Prime Minister rightly put an emphasis on prevention, rather than simply treatment. What are the Government doing in the area of prevention? It is not just the baby-boom generation who went to rock concerts; it is also the under-25 generation using iPods. A recent French study calculated that one in 10 of such users will have hearing deficiencies within two years, because they use these devices almost every day, and they play them at much too high volumes. Surely, prevention should be moved massively up the Government’s agenda.
Baroness Finlay of Llandaff: My Lords, I thank my noble friend Lady Howe for instigating this important debate. Her introduction demonstrated that she is certainly an expert in the field.
Hearing impairment is the most common sensory disability worldwide. Although deafness and loss of hearing are more common in the elderly population, many children and young people are also affected, with potentially devastating results on the development of language, communication and learning. There are estimates that in the UK, one in 1,000 children is deaf at the age of three. Currently, a staggering 17 per cent of the population have some deafness. As the noble Lord, Lord Giddens, said, in the younger age group that is likely to rise almost exponentially because of the sound technology they use on a daily basis. There are 20,000 children aged 15 and under who suffer from a degree of deafness, and 12,000 of them were born deaf.
Sufferers of deafness often experience isolation and depression. When deafness is of sudden onset, it is particularly devastating. The person with sudden onset deafness suddenly loses all orientation. Crossing the road or even pursuing activities in the home becomes incredibly hazardous. Even those with progressive deafness may find that they cannot pursue their previous employment, or find that employment opportunities wither, as their lives rapidly become narrower and more cut off. They are often acutely aware that their potential contribution to society is being wasted and that they cannot enjoy the same quality of life as they did when they had hearing or as those with good hearing can.
Two million people in the UK currently use a hearing aid, but it is estimated that a further 4 million might benefit from one. The Government are to be commended on their commitment to reducing waiting times for digital hearing aids. They certainly have recognised the failure of many PCTs to give audiology services the priority they deserve. To address this, the Audiology Advisory Board, chaired most capably by Professor Sue Hill, has produced the National Audiology Action Plan. But I would ask the Minister whether the current referral-to-treatment waiting time for a hearing aid has improved at all. Is the target of providing a diagnostic test for audiology within six weeks likely to be reached by its target date of March this year, since last year’s 13-week target was not met on time?
Hearing loss does not occur in isolation. The associated vestibular disorders cause dizziness, vertigo, nausea, fatigue and sometimes tinnitus and, sadly, they are commonly misunderstood both by the public and by healthcare professionals. These symptoms represent the most common reason for GP visits by patients over 65, and indeed 40 per cent of the UK population aged over 40 have experienced symptoms of dizziness and/or imbalance.