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Mr. Dawson: Is there any time scale for the proposal to suspend sanctions?

Clare Short: As I understand it, the Arusha talks are due to begin in January and will be completed by the end of the year. I understand from former President Nyerere that he is willing to make such a recommendation, I think in the early part of the talks. The time scale will be fairly brief, provided that all goes well and the Government of Burundi come to Arusha, which we have every reason to expect. At last and thank heavens, we are looking at imminent progress.

Movement on sanctions will enable Burundi to begin to discuss the resumption of development support from the international community. There has been lots of support, and we played a part, but the tragedy is that, although emergency humanitarian assistance is absolutely essential in war, it simply props people up as the war goes on, their livelihoods are destroyed and their families killed. Whenever we can, we want to get to development assistance and beyond emergency humanitarian assistance.

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At a meeting in Ottawa in August hosted by the Canadians, donors discussed the possibility of implementing an expanded programme of humanitarian assistance for Burundi, but that would limit assistance--this is all part of the regional leadership's efforts to achieve peace through the talks--to support for non-governmental organisations and UN agencies. We believe that that is a welcome step forward, but it is a second-best option. The Government of Burundi need support to help them to develop economic and social frameworks which can start a process of equitable economic and social development.

To prepare for that, we have encouraged the World bank to help to draw up a transitional strategy, and we are keen to get behind that. Since 1993, Britain has provided more than £38 million of humanitarian assistance in Burundi, but we are keen to move to the next stage--reconstruction, peace and getting the country moving. Historically, we are not a big donor or contributor to Burundi, and it is impossible for us as one country to work effectively everywhere. We are trying to get an international system that can work effectively everywhere.

We are willing to play our part in the reconstruction effort, but we will put particular emphasis on working with the multilateral agencies--the World bank and the EU--and the UN agencies to get a reconstruction programme that is as effective as possible so that those children, and Jean Jacques Rousseau, can look forward to a return to childhood and an education, and to growing up and having their own children without ethnic hatred and war savaging their futures.

As my hon. Friend the Member for Bethnal Green and Bow said, the situation in the great lakes is particularly tragic. We in Europe, scarred as we were at the end of the second world war by the experience of genocide, have seen it replayed in the great lakes and, to the shame of the world, failed to intervene to prevent another genocide. We have special historical responsibilities to try to secure an improvement of life for the children and people of the great lakes. We are doing all that we can to try to make sure that things improve, and the report from former President Nyerere in Brussels on Sunday night suggested that, at last, we can look forward to considerable progress.

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Audiology Services

12.58 pm

Dr. Jenny Tonge (Richmond Park): Many people in the House may know that I am totally deaf in one ear. I make no secret of that; I have always found it quite useful to be able to turn a deaf ear to three teenage children and their music at 2 o'clock in the morning; to aircraft noise, which plagues my constituency; and--dare I say it?--to the House of Commons, on occasion.

I also share a few of the problems faced by people who are deaf in both ears, and they are getting worse. Three out of 10 people aged over 55 have this problem. Ten years ago, the Medical Research Council institute of hearing research revealed that there are 8.7 million deaf and hard of hearing people in the United Kingdom. Given our aging population, that figure is probably much higher now. The MRC reckoned that 5 million of those deaf people would benefit from a hearing aid, yet two thirds of them have never tried one.

Every Member of Parliament represents an average of 4,500 constituents who are missing out because they cannot hear very well. They are missing out on enjoying and making the most of life. Hearing problems can affect work, family and social life. They reduce confidence and create stress. People may struggle on with their lives, but they become increasingly isolated.

In a recent report, the Royal National Institute for Deaf People gave several examples, one of whom was a 58-year-old man, Maurice Strong, who lives in my borough. Before he had a hearing aid, he went out of his way to avoid conversations, but now he will talk to any one. He highlighted how hearing loss affected his marriage. When chatting with his wife, he found it increasingly hard to hear what she was saying. We all have that problem. He said:


Sometimes it may be, but in his case it was not.


    "I'd accuse her of mumbling and we'd end up arguing."

That would ruin their weekend. He also faced stress in the workplace. As a security operator, he was worried that he would not hear sounds. He said:


    "I got so tired trying to compensate for my hearing problems. I'd come home in the evening, have my dinner and just fall asleep."

That is also a common problem, whether people are deaf or not, but the deaf suffer more stress during the day than the rest of us.

There is no need for these problems to occur. The RNID is having a publicity campaign to highlight the seriousness of deafness. For a start, we must take hearing tests as seriously as eye tests. A MORI poll carried out for the RNID revealed that only 22 per cent. of people over 55 have had a hearing test in the past 10 years, whereas 87 per cent. have had their eyes tested. That is in spite of the fact that almost half the over-55s have a hearing loss. Like sight defects, hearing problems often herald a more serious disease.

People do not get their hearing tested as a matter of course as they get older, as they do their eyes. We must overcome that fundamental problem. Wearing a hearing aid should be as acceptable as wearing glasses. Perhaps we should also stop making fun of people who are deaf. It is easy to do that: it is the Cinderella of afflictions.

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People with many other afflictions receive sympathy, but the deaf are laughed at, so we must try to change public attitudes.

If change is to occur, it must start with what is said--or often not said--in general practitioner surgeries. A significant number of people who consult their GP about a hearing problem are not referred for a hearing assessment. When I was a GP, I may not have heard what my patients said, and should perhaps have been referred at the same time. If people are not referred for a hearing assessment, they do not get a hearing aid. GPs play a crucial role in finding the one in five adult patients who are hard of hearing.

In the past year, the RNID has taken steps actively to support and inform GPs in carrying out this task. In June, it mailed 39,000 GPs in England, Scotland, Wales and Northern Ireland to give them warning of the possible increase in the number of patients requesting a hearing test. GPs were sent leaflets explaining the campaign to get them to ask all patients over 60 whether they are experiencing problems with their hearing. The aim is to persuade GPs to introduce the topic, and to refer patients for hearing assessments sooner rather than later. That is plain common sense, because the sooner people get a hearing aid, the more likely they are to get the best out of it.

GPs were also given a guide--a scratch pad--so that they would know what questions to ask if they were unclear. So far, more than 2,000 GPs have requested further information. That shows the widespread support for the campaign among GPs, and the lack of advice and information that they have so far been given by the national health service.

There is a limit to what the RNID can do. Indeed, the charity has already achieved more than the Department of Health. The Department must ensure that changes occur in audiological services. At present, the quality of service in an area is too dependent on the resources and priority that a local NHS trust gives to audiology. Waiting times, staffing levels, the range of aids available and the standard and quality of follow-up and rehabilitation are too variable and inconsistent. As in other areas of the NHS, it is diagnosis and treatment by postcode.

The time a patient has to wait for a hearing test varies. In some places there are hardly any waiting lists, whereas in others people may wait months. In London, people wait 15 weeks on average for a hearing test at the Central Middlesex hospital, but only 14 days at the Edgware and Hillingdon hospitals and the West Middlesex university hospital. Across the United Kingdom, the minimum wait for a hearing test is three days, and the maximum wait is a staggering 78 weeks.

It must be stressed that obtaining a hearing test is only the first hurdle that people must overcome. People are frequently embarrassed about their hearing loss, and more often than not they deny that there is a problem. The last thing they need is a lengthy wait to obtain a hearing test. There are too many psychological barriers to obtaining a test, without the NHS creating even more.

We construct barriers--in some cases, at every stage of the process of obtaining a hearing aid. Even after the long wait, many patients face a further long wait to obtain the appliance. In some places, the waiting time for a hearing aid is only a month or so; in others, the wait may be almost a year. In London, waiting times vary from a

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same-day service at the Royal London hospital--why it can achieve that and no other hospital can, I do not know--to a 364-day wait in other hospitals. A further difficulty may face patients. Following a hearing test, they may be offered only one hearing aid when they need two. Hearing aids are rationed.

The level of undetected hearing loss is immense, and in many areas there are serious problems with NHS audiology services. In considering those two basic facts, surely we cannot escape the conclusion that some initiative is required from the Government. I would welcome an announcement from the Minister that the NHS will rise to the challenge of working hard to reduce the number of people who are not benefiting from hearing aids. That figure is 3 million, and nothing helps concentrate the mind more than the setting of a target. I agree with the RNID that we should aim to reduce the figure to 2 million in the next five years. That is a modest target. What is the Minister's view? Will he consider a target being set by his Department?

It is reasonable that, once people have been referred by their GP, they should not have to wait more than a month for a hearing test or more than two months for their NHS hearing aid. A further target which should be considered by the NHS is the provision of a greater range of hearing aids. Digital technology is developing rapidly, but digital aids are rarely available on the NHS. In other areas of medicine and surgery, modern technology has almost taken over from the surgeons and physicians. How long will it be before national health service patients benefit from the new technology of digital hearing aids?

I look to the Minister to recognise publicly the serious problem that is faced by people who are deaf. It is no exaggeration to say that deafness can wreck marriages, stall careers and make people socially isolated. It needs to be remembered that, although the problems that are caused by unrecognised deafness can be immense, the average cost of fitting the present NHS hearing aid is only £90. Few NHS treatments come as cheap as that.

I understand that there are ever-increasing demands on the NHS--indeed, that is why my party consistently asks for a debate on national priorities in the NHS--but quality rather than the length of someone's life is the most important factor; quality of life is what we should look at. Increasing deafness destroys quality of life. I beg the Minister to improve our services for those.


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