House of Commons Hansard Debates for 28 Apr 1989

Miss Emma Nicholson (Torridge and Devon, West) : Does my hon. Friend agree that the Hearing Aid Council provides the valuable function of setting examinations for hearing aid dispensers and dealing with their results? Does he further agree that it is ludicrous that two different sets of examinations are run for hearing aid dispensers, one by the National Health Service and one by the private hearing aid service? What is the purpose of these two completely different examinations which result in two different streams of people emerging to give this crucial, though small, service to the public?

Mr. Colvin : I am obliged to my hon. Friend for her intervention ; but her question should more correctly be directed to the Under-Secretary of State who is to reply to the debate. I agree that there is no logic in what she describes, and it seems pointless to have two sets of examinations, particularly when the Ministry responsible is the Department of Trade and Industry. The Department of Health has been mentioned, and its involvement in this subject is important. There is a good case for saying that my hon. Friend the Under-Secretary should not be sitting on the Front Bench today. He is always welcome, but a Minister from the Department of Health would be far more relevant.

The Hearing Aid Council is felt by some, including the Royal National Institute for the Deaf, to be ineffectual because of the limited sanctions it can impose in cases of non-compliance. I was pleased to see that amendment No. 2 has also been selected for debate because the matter of imposing sanctions on people who break the rules and the code of conduct is important.

Mr. John Bowis (Battersea) : I shall return to the question of dual qualifications. Perhaps when the Minister responds he will comment on this matter. If there are two layers and two alternative standards within the profession, what will happen in relation to our comparability with our European counterparts? Will people who wish to practise in this country post 1992 have to meet the standards of the private or the public sector?

Mr. Colvin : My hon. Friend makes a good point, which underlines the importance of ensuring the highest

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standards. We do not need to attain harmonisation in Europe, because that would be too broad a concept. However, we must ensure that the qualifications of professional people are of the highest standard. In most cases we accept people from Europe with doctorates and qualifications of a lower standard than those in this country, but those standards must be brought up to our own, otherwise such people should not be permitted to practise.

Miss Nicholson : Does not my hon. Friend agree that our goal in relation to hearing aid dispensing and the relevant examinations should be to achieve the best practice? Undeniably, the Germans have introduced the best practices and we should take careful note of the way in which the Germans have made the dispensers of hearing aids part of their paramedical team and have a better system than we do. We should not knock our European colleagues when their practices are better than ours.

Mr. Colvin : I am reassured to learn that German standards are higher than ours. Siemens, which is a large company that is trying to take over the Plessey company in my constituency, is much involved with hearing aids. It is a most unwelcome takeover bid--I could not miss the opportunity of making that constituency point. Siemens is an extremely powerful company and it is nonsense to set fines for people who break the rules on hearing aids at £1,000. Siemens could afford to pay £1 million and still not notice it.

Miss Nicholson : Does my hon. Friend agree that we should welcome the Minister who is here today from the Department of Trade and Industry because he will be interested in takeover problems, whereas a Minister responsible for health would not be?

10.30 am

Mr. Colvin : I am obliged to my hon. Friend. If we are not careful, we shall be called to order, and the Minister will not know whether he is listening to a debate on hearing aids or a debate on takeovers.

Mr. Graham Riddick (Colne Valley) : I want to sound a note of caution at this point. My hon. Friend the Member for Torridge and Devon, West (Miss Nicholson) has mentioned standards in Germany. One of the dangers facing a variety of industries in Britain is that the European Commission will start to lay down standards oriented towards the German rather than the British economy. It will give the Germans a great advantage in 1992 and thereafter if we do not lay down slightly more general standards for the future.

Mr. Colvin : I take the point, but my hon. Friend will forgive me if I do not reply in detail to it. I am sure that the Minister has heard it.

Miss Nicholson : Will my hon. Friend give way?

Mr. Colvin : I am afraid not, because we must make progress. I want to say a word or two about the background and to refer to the document, "Hearing Aids : the Case for Change", put out by the Royal National Institute for the Deaf. Incidentally, I pay tribute to Rosalind Oakley, the institute's parliamentary officer, who has been of enormous help to hon. Members in preparing for this debate and, in general, with matters relating to the deaf.

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The House will be interested to note that there are 350 ENT consultants in this country. There are 700 audiology technicians and 635 registered private dispensers. But there are 3.9 million people with hearing loss who might be helped by a hearing aid. The Government have been very good about taking advice from the specialists. Their views are always noted, but the RNID's point is that it is high time that the consumers' case--the case of these 3.9 million people--was given a fair hearing.

The present hearing aid services are failing to satisfy many chronic problems and consumers are not receiving the service that they should. In the first place, there are long waiting lists. I mentioned earlier the case of one of my constituents. The average wait for an ENT appointment is 16 weeks, and it can take up to two years to get an appointment. A further 14 weeks can often pass before a consumer is finally fitted with a hearing aid.

There is a staffing crisis in the Health Service. In some parts of the country hearing aid services have virtually collapsed because of these shortages and because of problems with recruiting new audiology technicians. There are certain neglected groups. The Office of Population Censuses and Surveys has carried out a disability survey which identified almost 250,000 adults with hearing loss who are living in communal establishments. Almost without exception, hospital departments cannot offer services to those consumers.

It is also important to record the worries about inconvenient locations. For many people, the hospital hearing aid centre is neither local nor convenient. Consumers are obliged to attend at least two or three times to obtain their first hearing aid, and in most places they must return whenever they need batteries or a replacement aid. That is not good enough.

The RNID also believes that the service is ineffective. After receiving a hearing aid, 20 per cent. of consumers do not use it. Studies and pilot projects have confirmed that use and benefit can be maximised by good advice on fitting and follow-up visits to deal with any problems, but that cannot easily be done by a hospital-based service that is already under strain. We believe that there is inadequate protection.

Many consumers buying an aid privately from a dispenser who visits their home find that they are subject to high pressure sales methods--a point that was touched on earlier. They lack information about the conditions of sale and the back-up services that they can expect. The Hearing Aid Council is charged by Parliament with maintaining standards of trade practice, but it fails to do so effectively.

Training has already been mentioned by my hon. Friend the Member for Torridge and Devon, West. People who test and fit hearing aids and give advice on their use in the private sector are trained differently from those who do so in the NHS. The two sectors have no commonly agreed and recognised standard of training.

The Government are reviewing the organisation of the National Health Service now. Surely this is a golden opportunity to review hearing aid services. I congratulate the Royal National Institute for the Deaf on having examined the strengths and weaknesses of the NHS alongside the benefits and abuses in the private sector, and on the way in which it has argued the need for a reorganised system in its 28-page booklet, "Hearing Aids : the Case for Change".

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As my hon. Friend the Member for Basingstoke said, this new clause is similar to one moved in Committee. The fundamental difference is that this one gives the Government the discretion to intervene ; it does not place a mandatory obligation on them to do so. We must ask whether the Hearing Aid Council is doing its job properly. There are obvious doubts about that. My hon. Friend the Member for Torridge and Devon, West wants to abolish the council altogether--

Miss Nicholson : I am a sponsor of this excellent Bill and I congratulate its originator sincerely. Ultimately, I believe that the present proposals in no way match the overriding need. We shall have to look further at a later stage than this Bill to find the solution that we seek.

Mr. Colvin : That was a useful intervention. I draw the attention of the House to the speech made by my hon. Friend on this subject earlier this year. Their Lordships should read it, too, because it was important.

We must ask whether the council has succeeded in drawing up adequate standards of competence and codes of trade practice in this important industry. Many people think that it has not. On March 15, my hon. Friend the Member for Chislehurst (Mr. Sims) asked my hon. Friend the Minister when he last reviewed the Hearing Aid Council's code of practice. My hon. Friend the Under-Secretary replied : "The Hearing Aid Council Act does not require or permit the Secretary of State to review the council's code of practice. The Act requires the Secretary of State to approve the code proposed by the council and any amendments that it proposes to it. The Secretary of State can make his approval conditional upon certain

modifications."--[ Official Report, 15 March 1989 ; Vol. 149, c. 261. ]

Perhaps this power to impose conditions provides what we want. I hope that my hon. Friend the Minister will expand a little on that when he replies to the debate.

As things stand, the Secretary of State can only modify standards and codes that are put to him by the council. He has no proactive powers. Even if there were an overwhelming demand for change, the Secretary of State would be quite powerless to act or to intervene if the council itself refused to act. A good example was given in Standing Committee C, and all I shall do is to draw the attention of the House to the opening paragraphs of column 4 of the Official Report, because there is no point in putting something on the record twice.

The Government are demonstrating a benign faith in the composition of the council and are hoping that that will solve the problems. I believe--this is the purpose of new clause 1--that the Secretary of State should have reserve powers to fall back on if necessary. When my hon. Friend replies to the debate, I should like him to explain why he feels that such powers are not necessary.

New clause 1 would allow the Secretary of State to intervene in the running of what we can only describe as a quango. I was under the impression that this Government were pretty good at abolishing quangos. Therefore, I take up the challenge issued by my hon. Friend the Member for Torridge and Devon, West and suggest that the Secretary of State might extend his quango hunt in this instance. While it exists, the council must protect the interests of hearing aid users.

Miss Nicholson rose --

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Mr. Colvin Yes, I shall give way once more, but then I must conclude.

Miss Nicholson : The accepted definition of the word "quango" is something appointed and paid for by the Government. Does my hon. Friend agree that we have an even more peculiar anomaly here, because the Hearing Aid Council may be appointed by the Secretary of State for Trade and Industry, but it pays for its activities itself?

Mr. Colvin : The funding of the Hearing Aid Council is another major issue that should be addressed in the other place. I understand that the council is funded by raising fees from manufacturers registered with it. That raises the question of the role of the council. With the opticians, the General Optical Council is given a much wider brief to undertake training and other duties and has a broader source of funding, including Government money.

Mr. Ieuan Wyn Jones (Ynys Mo n) : Will the hon. Gentleman accept from me that a substantial proportion of the council's costs over the years has been related to disciplinary proceedings and that the cost of disciplinary proceedings to the council is particularly heavy? Does he agree that one of the merits of the Bill is that under it a disciplinary committee can order a dispenser who has breached its code of discipline to pay the costs of that hearing and that in that way the costs of the council could be significantly reduced?

Mr. Colvin : I am most obliged for that intervention as it raises an extremely important point. I hope that the hon. Member for Ynys Mo n (Mr, Jones) will succeed in catching your eye, Madam Deputy Speaker, because I am sure that the House would like to know his views on new clause 1.

The new clause would compel the council to investigate complaints from the public. At present it is under no obligation to do so. I do not believe that that proposal would mean that the Government would become interventionist. I understand the reluctance of a Conservative Government to take any form of additional powers. My hon. Friend the Under-Secretary of State made that clear in Committee. The present system, which was set up under the Hearing Aid Council Act 1968, has not worked well and will have little to celebrate on its 21st birthday on 24 May. Incidentally, that is only two days after the birthday of the hon. Member for Ynys Mo n, who has promoted the Bill, and who, I believe, will be celebrating his 40th birthday two days earlier. I thought that when the Conservative Government were elected 10 years ago, on 3 May--another celebration is coming up soon- -they were in the business of abolishing the Department of Trade--

Mr. Forth : What?

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Mr. Colvin : Yes, my hon. Friend the Under-Secretary of State was in Europe at the time and probably does not remember the manifesto on which we fought that election.

The Department of Trade and Industry is a wholly interventionist body which we do not need unless we need to intervene in industry. It may have some benefit to the economy, but I reckon that the old Board of Trade was very much better. In fact, it was the old Board of Trade that featured in the original 1968 Act. The nub of what we are saying this morning is that the Department of Trade

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and Industry is the wrong Department and that the Department of Health should be responsible in this sphere

Miss Nicholson rose --

Mr. Colvin : No I shall not give way, because I must conclude. I think that the Royal National Institute for the Deaf got it right. We must ask whether the Hearing Aid Council should be a medical council. We could well look at the workings of the General Optical Council, which is the equivalent of the General Medical Council and the General Dental Council. They are statutory health bodies with twin responsibilities for education and training, and with disciplinary functions. We are in the middle of reforming the National Health Service, and this is a superb opportunity for us to do something about the Hearing Aid Council.

I am a strong supporter of the Bill and support my hon. Friend the Member for Basingstoke, who moved new clause 1 so ably. It is essentially a probing provision. I do not think that there will be any question of pressing it at the end of the debate. We shall listen with great interest to what the Under-Secretary of State says in reply, and I hope that our remarks this morning will be noted carefully in the other place when the Bill reaches there, as I am sure that it will.

Mr. Bowis : I shall not follow some of the discussions that have taken place during the speech of my hon. Friend the Member for Romsey and Waterside (Mr. Colvin), much as I enjoyed the points that he made, especially on quangos. It seems to be not so much a question of sine qua non as sine qua quango, but we could look at that issue on another day.

First, I congratulate the hon. Member for what I know as Anglesey, but what I think Hansard knows as Ynys Mo n (Mr. Jones) on bringing the Bill to the House. It is a good measure and I hope that we shall shortly speed it on its way through its Third Reading and into implementation.

I pay tribute also to the Bill's co-sponsors. It is good that the next two names on the Bill are those of the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) and of my hon. Friend the Member for Torridge and Devon, West (Miss Nicholson), who have shown just how an individual can overcome the difficulties of disability and play an active part, not least in the highest chamber of the realm. However, we need to assist those who, through no fault of their own, cannot achieve such heights and ambitions, and this measure is geared to making life a little easier for them. The House of Commons is at its best when dealing with such issues. It comes together to represent those who need our assistance, and this is one of those occasions on which there is virtual unanimity of view that we want to do our best by such people. I am sure that the promoter of the Bill will agree with that.

It was interesting to note that the record of the proceedings in Committee reflected the good will on all sides. If I have one slight criticism of the Bill's sponsor it is that he seemed occasionally all too ready to accede to the Minister's persuasive powers, not least on questions of comparability. I understand the reasons for seeking comparability with other measures, but occasionally one should say that, if a solution is right for one problem but

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out of kilter with other measures, perhaps it is the other measures that should be brought into line. Perhaps my hon. Friend the Member for Basingstoke (Mr. Hunter) will develop that theme.

The key sentence in the briefing material provided by the Royal National Institute for the Deaf was the request that, whatever we did to improve the service, it should be geared to the consumer and not to the specialist or the salesman. That is right, because we must put the consumer first.

We all have knowledge of deafness. Some hon. Members may have close family members who suffer from deafness, as I have. In some instances, deafness is present from birth, while in others it comes later in life. It is almost worse when it comes later in life, because then one knows what one has lost. For someone who has had full hearing earlier in life, the frustration that comes when hearing starts to fade is extremely painful and difficult for others to understand. Perhaps the measure will enable more people to understand that frustration. The purpose of the new clause is to push that a little further.

I have experience in my family of the provision of equipment, and I know that a long time is needed for adjustment. My hon. Friend the Member for Torridge and Devon, West spoke about that in the excellent debate that she initiated. All too often, there is a

take-it-or-leave-it attitude. We need to ensure that there is a good basic after-sales service. That service should apply not only to the equipment, to make sure that it is in working order, but to the user, to make sure that he is in working order and able to use the equipment adequately. Above all, it is a question of making sure that the after-sales servicer has the patience to encourage and train the user of the equipment.

I shall give another example of an area in which we need to keep pushing in order to improve the service. I remember a visit I paid to a consitutent : eventually, after a great deal of knocking on the door, I gained admittance and found the elderly lady watching television with the sound turned off. I asked her why she did not have the sound on. Eventually, when she could understand what I was saying, she said, "I cannot hear the sound so there is no point in having it on." I asked her why she did not get a hearing aid, and she said, "I have a hearing aid, but I cannot make it work." She had a soundless television and was leading a soundless existence, even though she had a hearing aid that she could wear. The problem was that she could not cope with the little wheel that adjusted the volume, because she had arthritic fingers.

Codes of practice are needed in such cases to make sure that alternatives are provided for such people. We do not want the take-it-or-leave-it attitude one sometimes sees. In that instance, I spoke to somebody from the industry and he was helpful in locating a suitable piece of equipment. However, my meeting with him was by pure chance, and the first people that I asked from the social services and elsewhere did not know of anything that was suitable for people with arthritic fingers.

The new clause takes us a little further in keeping the pressure on. I know that the Hearing Aid Council is involved in training and education qualifications. The measure may encourage the council to play a wider role in the community so that we can get closer to the prevention of some hearing problems. My hon. Friend the Member for Romsey and Waterside (Mr. Colvin) talked about noise, which may be the noise of shooting or of music in

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the ear. If we can prevent, we will not need to cure, but when we need to cure, we must do it with compassion and patience, using all the technology that is at our disposal.

Miss Nicholson : Hon. Members were kind enough to let me intervene during their speeches. I should like to comment on some of the important points raised by my hon. Friends the Members for Romsey and Waterside (Mr. Colvin) and for Battersea (Mr. Bowis). The first matter is prevention. I think first of the 12-year-old who is profoundly deaf because his mother had measles, although I suspect it was probably German measles. What more compelling reason could there be for seeking to transfer responsibility for hearing aid provision from the Department of Trade and Industry--unfairly beleaguered in the debate over its interventionist stance, but that is another story--to the Department of Health?

The prevention of deafness through immunisation against German measles should be common in this country. I was distressed to learn that a boy of 12 should have been born profoundly deaf because his mother had what I suspect must have been German measles. Presumably, that was because she had not been immunised. I am deafened because my mother had German measles when she was carrying me, but I am 47 and when I was born immunisation was not commonplace. The magnificent thing about being a woman Member of Parliament is that one is perennially young, which is a great relief. The men get older, but we do not.

Children should not be born deaf through lack of immunisation and I am anxious to see the Department of Health attending to immunisation through education programmes persuading mothers to be immunised. My hon. Friend the Member for Battersea said that technology and dispensers must be user- friendly. Here I must part company with him, despite his great sympathy and understanding for those who suffer from a handicap and fail to find the proper technical provision. I have first-class hearing aids and sometimes can hear all too much in this place.

The National Health Service is technologically far outstripped by private sector provision of hearing aids. That shows that competition is important, because it means that innovation thrives, most properly, in the private sector. I am sure that the hon. Member for Ynys Mo n (Mr. Jones) would not wish me to press that point too strongly. There are many different varieties of hearing aids with different refinements in the private sector, but the National Health Service is still in the age of the dinosaur.

I also take issue with my hon. Friend about the quality of the after-care service or the dispensers in the National Health Service. The after-care service is first-class and cannot be faulted. National Health Service dispensers are gravely let down by the paucity of technological development in the hearing aids that they provide. That is the problem, and there is no point in saying that the 250 or so varieties of hearing aid that the private dispensers can offer will ever be transported into the National Health Service system. Technological change continues and it outstrips the NHS.

We have to take NHS funding for hearing aid provision away from the major hospitals and into the private sector, into the high street. What a ludicrous situation ; there are well over 3.5 million people who need hearing aids--I

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believe that that estimate is far too low-- yet the way we offer them hearing aids is to force them to have appointments with 350 ear, nose and throat surgeons who surely have better things to do, since probably more than 95 per cent. of people with hearing loss cannot be helped surgically. Thus the time of ENT surgeons is wasted, and people are disadvantaged for no good purpose. The screening method in the National Health Service for the provision of hearing aids is so fine that it is effectively stopping people from getting the aids. 11 am

It is crucial that the best training be offered and the best qualifications obtained within the dispensing service ; hence the need for one set of examinations. It is no good suggesting that the hospital examinations are superior to the private ones : that is not so--they are merely different. It is very important that there be one standard under the Secretary of State for Health, because, unlike the provision of spectacles, if someone is given a significantly wrong hearing aid, his hearing can be irrevocably damaged.

That is why the training of dispensers to the highest possible standard is most important. I urge my hon. Friend the Under-Secretary of State for Industry and Consumer Affairs, together with the Secretary of State for Health, to look at the experience in Europe, particularly in Germany, and let us have a Hearing Aid Council under the Secretary of State for Health, together with a first-class self-funded trade association that elects its own members democratically and is not dictated to by the Government of the day. We do not want this peculiar, unbalanced animal, which unfairly forces the private hearing aid industry to pay for an organisation whose members it cannot elect. I believe that that is the way forward, even though this is an excellent Bill, albeit a temporary measure.

Mrs. Rosie Barnes (Greenwich) : As one of the sponsors of the Bill, I should like to add my congratulations on what I believe will be an admirable first step in the necessary improvements for people with hearing loss. I have first-hand experience of the hearing aid syndrome, being the mother of a 16-year-old boy who lost his hearing as a result of my having rubella in pregnancy. All too sadly, that problem has not been satisfactorily resolved.

There has been considerable debate about the quality of hearing aids offered by the National Health Service. To date, my experience has been entirely of services offered by the NHS. There are inadequacies and major problems. It is a tragedy for a teenager to see aids available in the private sector that are far more discreet than those they have to wear at an age when they are very sensitive about their appearance.

The National Health Service, however, is a most tolerant organisation for young people who have to wear hearing aids. It is a fact that young people and hearing aids are often rather incompatible. On occasion, my son has jumped into a swimming pool having forgotten to take his hearing aid out, and has ruined it. He has also, in a fit of temper, thrown a hearing aid across the room. In such cases, the NHS has a strength we would never find in the private sector. It understands the frustrations and difficulties faced by young people wearing hearing aids, and it will replace them in such circumstances.

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Mr. Ashley : I agree with every word spoken by the hon. Lady. Does she not agree with me that what she is saying makes a powerful case for more resources to be devoted to the National Health Service?

Mrs. Barnes : I agree absolutely. Like many other parents of children with hearing aids, I am facing strong pressure from my son for a hearing aid that fits entirely in the ear. His consultant has advised me that it would be entirely suitable for his hearing loss. As a teenager growing into the difficult years, he is naturally most concerned not just about how well he can hear but about how he looks. In fact, if he had to choose, he would often decide that how he looks is more important than how well he can hear. He will pretend he can hear when he cannot in situations when he would feel embarrassed to wear a hearing aid. This situation presents a powerful case for what the NHS offers young people.

If the only options available at the moment are in the private sector, I pose a serious question about the penalties applicable for malpractice. If, as I suspect, I will have to spend a considerable sum over the next few years, once my son is fully grown--growing children make very different demands on the hearing service than do fully grown adults--I believe the protections should be very sound. I feel that the service should be free, since I believe my son's hearing loss is no fault of his own--and no fault of mine, either. All too frequently we hear of pensioners having laid out large sums for hearing aids that just do not work. They either whistle and distort sound or they pick up background noise disproportionately. For one reason or another, these people just cannot get on with their hearing aids. Although the NHS may be slow and there may be inconvenience for out- patients, the follow-up service is guaranteed. This aspect must be considered carefully in relation to the private sector. I strongly support further regulation and certainly stiffening the penalties against anyone guilty of malpractice in this area.

I return to the point raised by the hon. Member for Stoke-on-Trent, South (Mr. Ashley). We are considering a health problem because of which, through no fault of their own, people suffer severe hearing loss. They need a hearing aid. I believe that technological developments within the hearing aid industry should be made available within the NHS.

Mr. Forth : I must resist any temptation to be drawn down the path of replying to some of the valid and knowledgeable points made by hon. Members about provisions through the National Health Service vis-a-vis the private sector, or about the responsibilities of the Department of Trade and Industry vis-a-vis the Department of Health. As I see it, these are not legitimately appropriate points for this debate, although I believe that hon. Members were correct to include them.

I will concentrate on the new clause, and, first, I shall deal with the two more subsidiary points. New clause 1 proposes to change the phrase "Board of Trade" in the original 1968 Act to "Secretary of State". I point out to my hon. Friend the Member for Basingstoke (Mr. Hunter) that this was done some time ago and the Secretary of State for Health has already identified it in the current version of the Act. Thus, that part of the new clause is redundant.

The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) referred to a matter that has not been picked up by

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many other hon. Members when he said that he preferred "shall investigate" to "may investigate". I understand his reasons, but at present the system is that complaints are initially considered by the chairman and registrar of the council. They make a judgment whether the complaint is sufficiently serious to be referred to the disciplinary committee. That acts as a very useful filter. The trouble with the wording of the new clause is that, if we were to force the disciplinary committee to consider every complaint, no matter how trivial or irrelevant--and there are a few like that--we would place an additional burden on the council and the committee and its resources. That is unnecessary, because there is every evidence that the present system works satisfactorily against a

background--this is a point that my hon. Friend the Member for Dorset, North (Mr. Baker) made earlier--of a number of complaints. However, the House might want to be aware that the number of complaints is surprisingly small.

The main point at issue is the argument whether we want to give the Secretary of State greater positive or proactive powers in this matter. I have listened to the debate carefully, and I have re-read the Hearing Aid Council Act 1968. I remain convinced that the provisions in the original Act, which so far we have not seen fit to change, are still adequate to deal with the kind of things that will be before the council.

According to the 1968 Act, the council shall submit to the Secretary of State for his written approval any standard or code drawn up. The Secretary of State, in approving that standard or code, may make the approval conditional on its being modified in such a manner as he may require. The Act contains real powers at the moment. Those powers are satisfactory and adequate, particularly in this context.

Many hon. Members have referred to the composition of the council. In changing the council's composition, as the Standing Committee did and as I hope the House will endorse today, we have produced a council that will have a different outlook and will look more closely at codes of conduct, training and many other matters that may be within its remit. It will therefore be able to have a relationship with the Secretary of State within the existing provisions of the 1968 Act that will operate much better, in a way that hon. Members would want.

For the reasons that I gave in Standing Committee I would, with regret, strongly urge the House not to accept the new clause if it is pressed.

Mr. Colvin : The Minister places a benign faith in the council's composition. My hon. Friend replied to a question from the hon. Member for Ynys Mo n (Mr. Jones) on 1 February. He stated that he carefully consulted certain bodies when making appointments to the Hearing Aid Council. He said that, in particular, he consulted the Society of Hearing Aid Audiologists and the Hearing Aid Industry Association about appointments representing the dispensers. He also referred to a long list of organisations that he consulted which have technical knowledge of deafness and audiological technical knowledge with reference to appointments of members representing the interests of the hard of hearing. I will not read out that list, because I gave my hon. Friend the Minister a copy before the debate started. The whole question of nominations is terribly important. How much does my hon. Friend consult? Will

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he tell us a little more about the consultation process? How much advice does he take from members of the public? In his reply on 1 February, my hon. Friend said that he would consult and that he was prepared to listen to representations made by any member of the public with a problem who cared to come and see him.

Mr. Forth : My hon. Friend has made an important point and I can give him the assurances he seeks. I agree that it will always be important fully to consult interested and knowledgeable bodies in these matters against the background of the change in the council's composition agreed by the Standing Committee, which will give users and consumers greater representation.

We also believe that we should, and give an undertaking that we will, consult those bodies to which my hon. Friend has referred, but, as I stated in my reply on 1 February :

"it is open to any member of the public with genuine involvement in 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."--[ Official Report, 1 February 1989 ; Vol. 146, c. 262. ]

I go further than that : we will always be prepared to consider the names of people given to us in good faith who could claim to represent the consumer of the product in a more general sense or in a private capacity, instead of necessarily always representing a particular body.

We have the facility for, and we intend to have, the widest possible representation on the reconstituted council to ensure that it is thoroughly representative and can carry the confidence of the dispensers, the industry and the consumers. After all, we must be most concerned with the users of the product and to guarantee, as far as we can, to deliver a satisfactory product that will meet their needs.

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Mr. Colvin : That was a very useful reply. How many of the 12 bodies which my hon. Friend the Minister listed in his reply on 1 February took the trouble to see him? We are saying that there must be consultations and the door must be open. However, do people take the trouble to put forward nominations?

Mr. Forth : When we look for nominees, we find that most of the bodies respond in one way or another. Our liaison and contact with them is, as far as I am aware, to their satisfaction and is fully workable. If there are any difficulties, I want to hear about them to ensure that they do not persist.

Perhaps I have not replied to all the points that my hon. Friends may have raised, and I apologise for that. If the new clause is pressed, I regret that I must ask the House to reject it, for the reasons that I have given. On that basis, I hope that we can make good progress and see the matter to a conclusion.

Mr. Hunter : I am in something of a dilemma. I genuinely believe that this Bill would be better with the addition of the new clause and, after nearly two hours of debate, I detect that quite a number of right hon. and hon. Members agree with me.

On the other hand, my hon. Friend the Minister is very positive in his assurance that the new clause is not needed. Whenever possible, one wants to avoid the hassle of a

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Division on a Friday morning. There is a way forward. As several hon. Members have said, hon. Members on both sides of the House will be watching the workings of the Bill very carefully. We may choose to come back to it in future. On that understanding, I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

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