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NHS Audiology Services

Motion made, and Question proposed, That this House do now adjourn.—[Joan Ryan.]

10.1 pm

Dr. Howard Stoate (Dartford) (Lab): In the United Kingdom today, 9 million people—nearly 15 per cent. of the population—suffer from some degree of deafness. Of those 9 million, 5 million would benefit from hearing aids; yet only 2 million people currently have one.

The introduction in January 2000 of the modernising hearing aid services project promised a step change in the way in which NHS audiology services were to be managed and delivered. Digital hearing aids, which hitherto had only been available privately at a cost of up to £2,500, were finally to be provided through the NHS,   and substantial investment was to be made available to audiology services to modernise their facilities and service. Since then a great deal has been achieved, and the quality of life of thousands of people, who are now benefiting from a digital aid for the first time, has undergone a dramatic improvement. It is an achievement of which the Government and its partner organisations, such as the Royal National Institute for Deaf People, can be justly proud.

While many patients have benefited in the last six years, a significant number of patients who are eligible for a digital aid, but have yet to receive one, are unlikely to have one fitted at any point in the near future.

David Taylor (North-West Leicestershire) (Lab/Co-op): I am grateful to my hon. Friend for giving notice of his willingess to give way. As someone with a perforated tympanic membrane and chronic tinnitus, I am one of the 8 million or so to whom he referred.

My hon. Friend mentioned the RNID. Is he aware of its approval of the scheme run in Leicester, my area, and six other parts of the country by Hearing Direct, which allows adult hearing aid users to receive telephonic advice and support encouraging them to continue such use without needing to travel to audiology clinics, thus saving them time and inconvenience? Is not the NHS doing quite well in bringing about such modernisation?

Dr. Stoate: I am pleased to hear of the innovative service in my hon. Friend's area. That is an example of the way in which the service can be, and has been, improved dramatically. If such a service were rolled out across the country, many people, including my constituents, would benefit. However, as I shall explain, it is not universal. Many parts of the country do not enjoy the service that my hon. Friend has managed to achieve in his area.

In the last year I have received dozens of letters from patients in Dartford, from people without an existing hearing aid, complaining about the length of the wait for a digital aid. I have also been contacted by a large number of patients with existing analogue aids, to whom the waiting list for a digital aid has been closed until recently. The distress and frustration that that is causing patients and their immediate families is, I need hardly say, considerable. It is particularly acute in the case of patients with existing analogue aids who are struggling to come to terms with the fact that they have no immediate prospect of receiving a digital aid.
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The digital hearing aid service for residents in the Dartford, Gravesham and Swanley primary care trust area is currently provided by Medway NHS Trust. At present, 244 patients in Dartford and Gravesham are waiting for a "first fit" digital hearing aid. There is currently a 10-month wait, which is considerably longer than the best practice standard in the RNID's patients guide, "A good audiology service—what you can expect", which was published in 2002. The guide states that waiting times should not exceed the following: from GP referral to first assessment, not more than four weeks; from assessment to first fitting: not more than four weeks; and from first fitting to discharge; not more than eight weeks. Although the level of service is far lower than the best practice standard, it still represents a far better service than that enjoyed by patients who have been waiting to have analogue aids converted to digital aids. Until very recently, patients in that situation had no hope whatever of receiving a digital hearing aid as the waiting list for conversions was closed in order to enable the service to focus its resources on patients waiting for a first digital aid.

Mr. Peter Bone (Wellingborough) (Con): The position must be different around the country because I have a constituent who makes the reverse complaint. She has been forced to have a digital hearing aid when she is happier with the analogue aid and we cannot get the analogue for her.

Dr. Stoate: It is unique to have the Opposition complain that a service is too good. Long may it continue. If only it were so across the country. The hon. Gentleman makes the valid point that the service is patchy across the country.

The waiting list for digital conversions has now been resumed in my area but the approximate waiting time is 32 months. As of 16 January, 951 patients in Dartford and Gravesham were waiting for digital conversion.

In the past year, considerable efforts have been made to reduce waiting times for new patients and they are now a lot less longer than they were 12 to 18 months ago, when it was common to wait a year or more for a first fitting. The staff running the service deserve a lot of credit for that. However, that improvement has been made at the expense of patients with existing analogue aids, regardless of their clinical need, which concerns me.

Medway NHS Trust claims that its hand has been forced to a large extent by the introduction of a new waiting time target for NHS and diagnostic services, which states that, by 2008, no patient will have to wait longer than 18 weeks from referral to hospital treatment. The trust has interpreted that target as meaning that "new patients", that is,

should be prioritised. That is stated in a letter from the Medway NHS Trust chief executive's office dated 25 August 2005. However, I would welcome clarification from the Minister on that point. In my opinion the waiting list target should apply to people with existing aids who have experienced further hearing loss as well as to people who have no amplification.
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Although the waiting list is now open again to patients with existing aids, patients are still facing an extremely long wait and I feel that a fresh approach, which is based purely on clinical need and is free from such arbitrary distinctions between patients, is necessary. When the modernising hearing aid services project was launched, the RNID recommended that patients with analogue aids awaiting conversion to a digital aid should undergo a clinical assessment, so that the most vulnerable and needy patients could be given priority. It is extremely disappointing, therefore, that that is not happening.

The national framework contract public-private partnership with David Ormerod Hearing Centres and Ultravox, which was introduced in 2003, also makes a distinction between new patients without a hearing aid and existing patients with analogue aids. The PPP programme has made a significant difference to the lives of many new patients since its introduction and has been an undoubted success in many ways. It has enabled thousands of patients, who otherwise would still be waiting, to receive their first hearing aid. That comes as little consolation to existing patients in Dartford, however, who are not eligible for the scheme and still face a prolonged wait for a new digital aid.

Mr. Philip Hollobone (Kettering) (Con): I congratulate the hon. Gentleman on securing the debate and on raising this important issue. Are not digital hearing aids a perfect example of the NHS finding it difficult to deliver medical improvements in technology, despite the best efforts of all its staff, the Government and Ministers? Is not that an example of the NHS finding it difficult to deliver the services that people want?

Dr. Stoate: The hon. Gentleman is right, but I shall explain some of the reasons for that. The fault is not the Government's alone, and the system has worked well in some areas, but the service is patchy and we must try to bring all areas up to the best level. It is not true that the NHS is unable to fulfil contracts and deliver a good service, as it is clear that it has managed to do so in many parts of the country.

It is apparent, however, that a lack of resources—that is, facilities, staff and finance—still hinders the NHS' ability to deliver the level of service that patients have a right to expect. The Department of Health announced in January 2000 that £94 million was to be made available to modernise hearing aid services in England and said that, by April 2005, the latest digital hearing aids would be available for those people across the country who could benefit from them. Although digital aids are available in north-west Kent, we are still a long way from achieving the unfettered access envisaged in 2000.

The Darent Valley hospital patient and public involvement forum has campaigned tirelessly on this matter, and has suggested that many of the present problems result from a shortfall in funding from the Department of Health. It asserts that Government funding has covered only the cost of the hearing aids themselves and the associated computer equipment. The funding also helped to meet some, but by no means all,
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of the extra staffing costs associated with the increased work load, and that has obliged local PCTs to make up the difference from existing funds—something that they struggle to do. One member of the PPI forum, John Beadle, has said that

to trusts,

Another major problem impeding the Dartford PCT's efforts to improve services is the shortage of suitable facilities. An outreach centre operated by staff from Medway, and using equipment from that trust, is available at Darent Valley hospital, but it consists of only one room. That is absurdly inadequate for an area with a population of almost 200,000.

Medway NHS trust has put together a business plan for the development of audiology services, and it seems likely that some of the capital will be used to fund the creation of an additional audiology room. Even with that extra room, however, the trust will still not have the level of facilities that it needs to deliver an effective service. It will still be far below the recommended level of provision set out in the best practice standards for adult audiology published in 2002 by the Department of Health and the RNID. In addition, even if the service is able to recruit and retain a full team of staff, and to ensure that a full range of equipment is made available, it still will not have the necessary facilities to house them.

Like all areas of the country, the service in Dartford is also affected by a shortage of audiologists. An audiology degree course has now been introduced and more qualified audiologists are now entering the profession but, with the demand for digital hearing aids continuing to increase, the service is struggling to keep up.

More and more people are seeking help with their hearing problems and that is, of course, to be encouraged. We have known for a long time that there is an enormous amount of unmet need around the country, and it is good that people are coming forward for help, encouraged perhaps by some of the recent announcements that have been made by the Department of Health. I am worried, however, that those people—some of whom might also have been encouraged to seek help by their friends and families—may quickly lose heart and give up when confronted by a lengthy wait for a fitting.

It is apparent that the lengthy waits experienced by patients in Dartford are common in many parts of the country. A recent survey carried out for the British Society of Hearing Aid Audiologists found that 41 per cent. of hospitals reported that queues of patients needing a hearing aid are longer now than in 2004. According to the society, it now takes seven weeks longer than it did in 2004 to see a specialist, have a hearing test and eventually get a hearing aid fitted.

The worst affected region is the south-east. By autumn 2005, the average wait there rose from 58 weeks in 2004 to 81 weeks, according to the BSHAA. In the north-east, the average wait went up from 18 weeks to 48 weeks, and the average wait in the west midlands is now 65 weeks.
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In some trust areas, the average wait is considerably longer still: the BSHAA reported total waiting times in 2005 of 130 weeks at the Royal Sussex County hospital in Brighton, of 156 weeks at Birmingham's City hospital, and of 106 weeks at the Queen Elizabeth the Queen Mother hospital in Margate. In contrast, the average total wait from referral to fitting is around 31 weeks in the east midlands region, and 35 weeks in the northern region.Again, that shows the existing disparity across the country. The speed of service that a patient can expect therefore varies widely from place to place, and that is clearly unacceptable.

Waiting times are by no means the only issue that patients are concerned about. For example, a number of people have also approached me with concerns about the level of choice that exists in terms of the types of digital aid available to eligible patients. Although in-the-ear aids are available to private patients, NHS patients have access only to behind-the-ear aids, which   many people find cosmetically unacceptable. Unfortunately, most NHS patients are unaware of this until they come to have a digital aid fitted. Not unnaturally, they are often very disappointed. This is particularly true of patients who receive their aid through companies involved in the public-private partnership scheme, which have of course spent considerable sums advertising availability of in-the-ear aids.

I am also concerned that, because of the pressure on local audiology services, patients who have been fitted with a digital aid may not be getting the rehabilitation and aftercare that they need to ensure that they make full use of the aid. The aftercare burden faced by audiology services has become even heavier since the introduction of the PPP scheme, as the companies taking part in it are not involved in the aftercare of NHS patients whose digital aids they fit. A telephone follow-up service has been introduced by the NHS, and it is clear that it is working in the constituency of my hon. Friend the Member for North-West Leicestershire (David Taylor), but it is not ideal and no substitute for ongoing, personal, face-to-face consultations.

It is clear that lack of effective service monitoring and audit arrangements at local level have contributed to the parlous situation in which many audiology services now find themselves. The Department of Health, the Royal National Institute for Deaf People and the National Institute for Health and Clinical Excellence have all published guidance on how local services should run. For example, NICE issued guidance on hearing aid technology as long ago as July 2000. It recommended that audits be performed to assess the performance of audiology departments. Two years later, the Department of Health and the RNID published their "Best Practice Standards for Adult Audiology", which set out the standards that

It concludes by saying that

It seems, however, that few trusts have been able to implement either the best practice standards or the NICE guidelines fully. In many places, no attempt whatsoever has been made to implement them. Moreover, since those guidelines were published, little
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or no attempt has been made at national level to assess the quality of service being delivered in terms of waiting times, or to see whether the guidelines are being adhered to.

Part of the problem up to now is that unlike accident and emergency or cancer waiting times, the Healthcare Commission does not take into consideration audiology waiting times in setting each trust's annual performance rating. This problem is compounded by the fact that the Department of Health does not collect records of waiting times in each trust on the fitting of hearing aids. Both those oversights need to be addressed if we are to have a more accurate understanding of the situation on the ground in each area.

The new Department of Health 18-week treatment target for audiology patients by 2008 is a welcome step forward, but as I have already alluded to, to whom this waiting list target actually applies needs to be clarified. Does it apply to all patients, or just to those without any amplification? I should also be grateful for clarification of the level of treatment that the target refers to. Does it apply simply to the waiting time from general practitioner referral to an appointment with an ear, nose and throat consultant, or to the waiting time from GP referral to final fitting? It needs to refer to the latter if it is to have any credibility. A more robust and transparent system of targets, assessment and audit is absolutely essential if the service is to improve across the country.

Resources remain the ultimate obstacle, however, to service improvement. I have already referred to the   straitened circumstances in which the audiology service in Dartford is operating. I hope that the accommodation problems that Dartford is experiencing are not the norm across the country. An assessment of the appropriateness of the accommodation in which each service is functioning needs to be carried out, and I ask the Minister to ensure that it is.

An assessment of the financial capacity of each service to deliver its basic commitments also needs to be carried out. The RNID document "Sustaining your modernised audiology service" maintains that adult services in England

The evidence from Dartford and from the BSHAA, however, suggests that trusts are finding it difficult to meet their obligations to patients, and that the funding provided is nowhere near sufficient to meet demand. Funding for audiology services ceased to be ring-fenced in April 2005 and audiology services now have to compete for funding with other health care departments. So it is unlikely that the funding situation will improve in the immediate future, given the state of most trusts' funding. Until requisite funding is made available that is based on an accurate assessment of the level of need in each community, audiology services will undoubtedly struggle to cater for existing demand.

In some ways, the Department of Health has become a victim of its own success in marketing digital hearing aids. In the past five years, thousands of patients have been persuaded, thanks to the efforts the Department of Health and the RNID, of the advantages that a digital aid can offer, and they have become aware of their availability on the NHS. Demand has therefore risen
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dramatically across the country, in most cases well beyond the capacity of the local audiology service. We cannot afford for the progress made in the past few years to be wasted. A thorough review of the way in which audiology is funded, delivered and monitored is therefore essential. I urge the Minister to make it a priority.

10.20 pm

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