The Parliamentary Under-Secretary of State for Health (Steve Brine)
I thank all hon. Members very much for their contributions. There are many ways I could spend a Thursday afternoon, but I have really enjoyed this debate and I have learned a lot. This has been a consensual debate, and I thank the shadow Minister, the hon. Member for Burnley (Julie Cooper), for the excellent tone of her comments. I really enjoyed what she had to say as well.
Like everyone else, I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the debate through the Backbench Business Committee, and also our signers. Thank you for doing what is a first and for working so hard. I cannot sign, but I can imagine that it is quite hard work to do it for three hours. There are two signers and they have worked really hard. Thank you for that.
I do not have a hearing problem, but I do have a sight problem, which is why I have a lectern in front of me. The papers are far too far away from me without it, which is why I always put it into play.
I thank the all-party parliamentary group on deafness, a number of whose members have spoken today, for all the work that it does in the House in raising awareness and improving the way we provide support. I cannot remember in my time in the House a debate on this subject, so it was certainly long overdue. All-party groups can do this; the Backbench Business Committee is excellent.
As we have heard, hearing loss is widespread, affecting one in six of the UK population, and it has a massive impact on the lives of our constituents and, indeed, some Members of the House. We have heard today really incredible contributions and—I agree with the hon. Member for Burnley—really moving contributions, especially from the hon. Member for West Lancashire (Rosie Cooper). There was not a dry eye in the House when she was speaking—thank you for the way you put things. I was going to intervene to give her a chance to have a drink, but she was brilliant in the way she put things. I thank her for that.
I shall highlight the key steps that the Government are taking to support those with hearing loss and deafness and then move on to the other important points raised by hon. Members during the debate. I apologise in advance in case I do not cover them all; I will write to hon. Members about any points that are not covered.
As we heard from the hon. Member for Poplar and Limehouse, in March 2015 the Department of Health and NHS England published “Action Plan on Hearing Loss”. That is a statement of intent for action across the health and care sector. There is an ongoing programme of work that the action plan has initiated. There are 20 separate outcome measures, which the hon. Gentleman touched on.
In September 2017—working with the Department for Work and Pensions, the Department for Education and hearing loss charities—NHS England issued a series of “What Works” guides, providing examples of what we know works in supporting individuals with hearing loss throughout their lives. Those guides, aimed at organisations, providers and commissioners, cover hearing loss and employment, the transition to adulthood for young people with hearing loss, and hearing loss and healthy ageing.
A key point in the plan is the need for clear guidance for commissioners, and in July 2016 NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”—snappy titles we do not do in the NHS, as I have learned since arriving there as a Minister. As the Minister responsible for public health, I am very pleased that that framework recognises hearing loss as a “major public health challenge”, because that is exactly what it is. The framework is a major step forward in focusing local commissioners on tackling uncorrected hearing loss and on addressing the variation in access to and the quality of services across the country.
The framework has been developed with a range of stakeholders, including voluntary sector groups and professional representative groups, such as Action on Hearing Loss, which has been mentioned today, and the British Tinnitus Association—ditto—which are members of the Hearing Loss and Deafness Alliance. The guidance is crucial in ensuring consistency across CCG commissioning in England and supporting commissioners as they make decisions on what is effective and good value for their local populations. In turn, it will help to reduce inequalities in access to and outcomes from hearing services. I recognise the need for us to maintain momentum and to ensure that the action plan secures positive outcomes for those with hearing loss and deafness.
Let me turn to the points—all of them, I hope—that have been raised. In response to the speech by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning), who I know had to run away—he is my former boss—I say this: not only am I not the Minister for Education, DWP, DCMS or others; I am not even the Minister within the Department of Health covering this area, but never let that stop a happy Minister.
I really enjoyed listening to the debate. The smartest way to respond will be to take the points that have been raised the most. The hon. Member for Poplar and Limehouse, in opening the debate; the hon. Member for Bristol East (Kerry McCarthy), who mentioned her constituent; my right hon. Friend the Member for Hemel Hempstead and pretty much all other speakers mentioned the Access to Work scheme. I recognise hon. Members’ concerns about the impact of changes to Access to Work. I understand that the hon. Member for Poplar and Limehouse will meet with the Minister for Disabled People, Health and Work early in the new year to discuss in more detail Access to Work and concerns he has about it.
Members will realise that I am not that Minister, who is my hon. Friend the Member for Truro and Falmouth (Sarah Newton), but I spoke to her at lunch time ahead of this debate and I was on the Front Bench with her this afternoon for the statement on the new Command Paper. We will speak after this debate to ensure that she is fully up to date with everything raised that comes within her portfolio.
I think it is worth putting it on record that resources for Access to Work were increased in real terms in the 2015 spending review. I appreciate that hon. Members have all spoken positively about Access to Work as a scheme, but resources within a publicly-funded health service are still finite and they need to be allocated to the growing numbers coming to the scheme—8% more people had Access to Work provision approved last year than the previous year, including 13% more deaf people. Last year, we spent £104 million on Access to Work grants, an increase from £97 million the year before. As has been said by a number of hon. Members, Access to Work is a demand-led scheme and therefore the number and level of awards will reflect that. We intend for it to continue to meet demand, and with that the numbers continue to go up.
I do not accept that the maximum level of support is too low. The help an individual may receive from Access to Work depends on their individual needs and their personal circumstances—up to the current maximum of £42,100 per year rising to £43,100 from April 2018. That is 1.5 times the average salary, which is far more than most of my constituents, and those of every hon. Member here, earn.
Transitional arrangements are in place for existing recipients and those who made a claim before October 2015. The changes do not apply until April 2018, provided that needs remain the same. People will receive annual reviews of their progress and support in the transition to the award level. The Government continually monitor the application of the cap and consider whether any further flexibilities might be required. That is another point I discussed with my hon. Friend before the debate; she is acutely aware of the situation.
It is not often that a Minister is able to stand up in a Westminster Hall debate on the day that something new has been announced and touch on something new. This Command Paper “Improving Lives: The Future of Work, Health and Disability” sets out our response to last year’s Green Paper consultation. In this document—a weighty tome that hon. Members and I will want to study—we set out how those users with the greatest needs, such as some British Sign Language users, will be offered new managed personal budgets, as well as workplace assessments involving their employers, to help to meet their needs within their award level. Deaf customers will also be supported by a dedicated team of special advisers.
The hon. Member for Eastbourne (Stephen Lloyd) had to get away, but he has returned. He is indeed a friend from the grand old days of the coalition, as he put it. I have noted his incredibly well-made point about SMEs. My right hon. Friend the Member for Hemel Hempstead made the point that those employing disabled people get a lower churn and a number of hon. Members reflected that message in their comments. I think it is absolutely right. A company based in my constituency called Microlink PC was mentioned in the Chamber during the statement. It works with large and small organisations—big banks in the City and small SMEs across the country—and the focus of its business is to use technology to help disabled people into work. That absolutely includes people with deafness and hearing loss. Many people across the charities sector also work to help that to happen.
I saw the hon. Member for Poplar and Limehouse during the statement earlier, standing on the back row, and I knew exactly what he was going to say, and he did not disappoint when he raised the issue of the cap. All I can say is that I wrote on my notes the comments of the Secretary of State—which I know the hon. Gentleman will have noted, too—and that I know the hon. Gentleman will bring the matter up with my hon. Friend the Minister for Disabled People, Health and Work when he meets her. The Secretary of State said he would continue to review, continue to look at the evidence. I encourage the hon. Gentleman to press on that and to continue to look at the evidence, because he has that there in black and white from the Secretary of State.
The hon. Gentleman also mentioned—as did the hon. Member for Eastbourne and the hon. Member for Blaydon (Liz Twist), who has also gone, and many other hon. Members—the legal recognition of British Sign Language and the case for a BSL GCSE. It is not entirely clear to me which Department would lead on legal recognition of British Sign Language, which is the problem that so many people have referred to today. I am sympathetic to the calls for strengthening the role of British Sign Language. We want to see as many people trained and providing support as possible. At this time, Her Majesty’s Government are not yet convinced that the way to achieve that is through legislation. The Department for Work and Pensions undertook an extensive market review, of which the final report was published in July, which demonstrated that communication requirements should be addressed on an individual basis and that there is no universal approach to addressing these needs.
We have protections of the legal rights of people who are deaf in the Equality Act 2010 and in the duties of the NHS—the mandate that I am responsible for giving to NHS England and publicly funded social care organisations—to conform to what we call the accessible information standard. I am happy to take that point away. It came across clearly from many hon. Members in this debate. All I will say is that the private Members’ ballot is a wonderful thing.
On the subject of the GCSE, any change to the school curriculum, particularly the establishment of new GCSEs, is a matter for the Department for Education and something that the all-party group will have to take up with it. I know from talking to the Department before the debate—I suspected that this would come up—that there are no plans at this time to introduce further GCSEs beyond those to which the Government have already committed, but something tells me that the hon. Member for Poplar and Limehouse, my right hon. Friend the Member for Hemel Hempstead, the hon. Member for Eastbourne and other hon. Members who have spoken today will, with their usual determination, follow this through with Ministers at the Department for Education, who will no doubt note their comments today.
The hon. Member for Poplar and Limehouse and the right hon. Member for Wolverhampton South East (Mr McFadden) talked about the assessment criteria for cochlear implants. Those were debated in March when the hon. Member for Poplar and Limehouse had an Adjournment debate in which he highlighted the report of the Ear Foundation and he called for NICE to review its cochlear implants technology appraisal. As the hon. Gentleman will know, NICE is an independent and expert body that advises us at the Department, and it has discretion to review its guidance in the light of any new evidence.
NICE is working on a list review for this particular technology appraisal and will consult with stakeholders in 2018, so I will make sure that he and all other hon. Members who have raised this matter get early sight of that and do not have to go looking for it or hear about it in the media. I am absolutely sure that this will include consideration of thresholds and criteria for getting cochlear implants. I understand that NICE is planning this consultation because of its recognition of how important this is, going beyond the usual review process. Although that does not give the hon. Gentleman the clarity he wants, I hope it is helpful to him in some way.
The hon. Gentleman and my hon. Friend the Member for Milton Keynes South (Iain Stewart)—who spoke excellently about this—talked about the provision of functionally equivalent telecoms services and video-text relay services. Obviously telecommunications does not sit within the Department of Health—no matter how big our remit, I do not think we have that one—but it is very good to hear that companies such as 3 and deafPLUS are at the forefront of delivering equivalent services for their hard-of-hearing customers. I wish deafPLUS all the best in the Helpline awards, which it has been nominated for. I understand that the Department for Digital, Culture, Media and Sport has previously considered the issue of provision of telecoms services, despite it being a commercial decision for the public-facing companies. This has included the Department engaging with companies and industry, and Ministers writing to the FTSE 100 companies seeking views. I hear that the feedback from that included the view that there were better means of meeting the needs of consumers with less reliance on video relay services. I am happy to raise the issues highlighted by Members with DCMS colleagues and see what further engagement there can be, and will of course recommend that they look at the Australia example that my hon. Friend the Member for Milton Keynes South spoke about in such glowing terms.
The Member leading the debate, the hon. Member for Poplar and Limehouse, raised the Deaflympics. I understand that the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), has instructed officials in her Department to look into how we can ensure greater recognition for the Deaflympics in this country, and she will consider their advice in due course. She is a very accessible Minister, and I know the hon. Gentleman knows her and will no doubt take that matter up with her as well.
A number of people, including the hon. Gentleman, my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bristol East talked about improving paediatric audiology services through the Improving Quality in Physiological Services—IQIPS—scheme. Concerns have indeed been raised in relation to accreditation of paediatric audiology services. The independent process of accreditation—the IQIPS services —is there to ensure all providers meet a common standard. We want all providers to have completed accreditation as quickly as possible. The commissioning framework encourages clinical commissioning groups to require providers to have completed the IQIPS self-assessment tool, and to have applied for and achieved accreditation, within the duration of their contract. Commissioners must be the ones who drive this forward. For us, the accreditation process is an effective means of testing against the standard. If during an assessment mandatory findings are raised that show nonconformity with any part of the standard, the service agrees appropriate improvement actions with the United Kingdom Accreditation Service team to rectify that and prevent it reoccurring.
The hon. Member for Poplar and Limehouse and many others raised the issue, which I even question myself on, of which Government Department leads on British Sign Language. I completely appreciate the frustration. There can only ever be one Minister at the Box, but what we really need is a triumvirate of me merged into my hon. Friends the Members for Truro and Falmouth, and for Chatham and Aylesford—that would be an interesting sight! I totally appreciate the frustration with the fact that no single Department leads on British Sign Language. I suppose, although this will probably just make it worse, it would depend on the context; if it is in education, that would be for the Department for Education; if it was how BSL is used in health settings in line with the accessibility standard that I mentioned, that would be for my colleagues in the Department of Health. I get the hon. Gentleman’s point, and will take it away.
The hon. Member for Eastbourne, whom I know well and is welcome back to the House, talked about screening for hearing loss in adults. He made the point very well that we do not focus just on people with complete hearing loss. He said to me the other day that he feared the debate would be about the deaf-deaf, as he put it, and he wants to ensure that people with partial hearing loss get the support they need. He made the point very well that people begin to lose their hearing later in life, as age catches up with us all, but accept it as part of the natural ageing process. They are often reluctant to admit they have a hearing problem, do not seek support as promptly as they might with other conditions and, as we have heard and as he said, often wait years before going for a hearing test. We heard his call for the introduction of a hearing loss screening programme for people at the age of 66, once they reach retirement, and as part of the NHS health check for people aged 40 to 70. I am responsible for the health check programme.
The advice from the UK National Screening Committee, the expert group that advises Ministers on all aspects of screening, is that the evidence does not demonstrate that universal screening would provide any hearing-related improvement in quality of life in comparison to hearing loss identified through other channels. However, the hon. Gentleman makes a persuasive argument that we can do more to identify hearing loss as people reach older age. He said that the general election had intervened, but as he also said, he is back, and I do not doubt that I will be hearing from him again on this subject, probably at Health questions in a couple of weeks’ time. I will be more than happy to do so, to be honest. He also mentioned that CCGs commission the audiology services. NHS England’s commissioning framework captures the importance of audiology, and monthly waiting time data for audiology is collected and can and should be used by Members and the public to hold commissioners to account.
I touched on my hon. Friend the Member for Waveney, who spoke about support for children with hearing loss, and about his constituent’s son, Daniel. I was the vice-chair of the all-party parliamentary group on autism for many years when I was on the Back Benches, and we often used to hear about the so-called middle-class parents with sharp elbows who managed to get their children what they needed. That is, of course, human nature; but it should not be the sharp elbows of the middle classes or of anybody else that gets children what they need—that is what the state is for, in my opinion.
Children with a special educational need as a result of their deafness will benefit from the more integrated approach to meeting their needs. Since 2014, a new framework has required CCGs and local authorities to make joint arrangements for assessing the range of eligible children’s needs, and the development of what my hon. Friend rightly referred to as the education, health and care plans to provide necessary support. Every Member in this debate and in this House has casework on EHCPs. These arrangements are transforming the support available to children and young people by joining up services for zero to 25-year-olds—that is their scope—across education, health and social care and by focusing on positive outcomes. He is right to take up the casework, as I would myself. I think the performance of local authorities is vastly different across the country. I know from speaking to him outside this debate that he is working very closely with his local authority, as I would expect, and that he has been impressed by the improvements it has made. I do not doubt that that is because of the pressure that he has put on it.
In my hon. Friend’s speech he used the term, which I wrote down, “The right support right from the start”. I do not think that was an accident, because as a Member of Parliament I had an invitation today, as we all did, from the National Deaf Children’s Society, which he referred to, requesting the pleasure of my company at an event called: “Technology and deaf children: Getting the right support, right from the start”. Mr Speaker has very kindly allowed that to be in the state rooms in Speaker’s House at lunchtime on 10 January. I think that will be an excellent event, and I hope it is well attended; I suspect it will be by all Members in this room.
My hon. Friend touched on special educational needs funding as well. The implementation of the new SEN system has been supported by significant new investment. That includes £70 million in ’14-15, £113 million in ’14 through to ’17 in the implementation funding, and £45 million in the same period for independent supporters for families. Ofsted and the Care Quality Commission are reviewing how all local authorities—authorities know about this—and their CCG partners work together to meet the needs of children with SEN as the EHCPs come into force. The assessment criteria are there, and are very much on their shoulders.
My hon. Friend the Member for Rochester and Strood (Kelly Tolhurst) gave a brilliant and very personal speech, if I may say so. It is never easy to do that in this place. It gets lots of retweets, but that is the easy bit; it is really hard to do it. She mentioned her mum’s story, and I thought she spoke brilliantly. She used the term invisible disability, which the hon. Member for Burnley also used. My hon. Friend said that deafness could take many different forms and have impacts physical and mental. I thought she made the case really coherently.
To touch again on my right hon. Friend the Member for Hemel Hempstead, my former boss, for the record, I do not mind at all when former Ministers come to debates that I am responding to, especially when they are former Ministers for a Department that I am not responsible for. I thought he made the point very well about the scale of the issue and the hidden deafness in this country, and he gave his example of industrial causes of deafness.
The hon. Member for Edinburgh East (Tommy Sheppard) told us about the BSL Act in Scotland and the ensuing national action plan, which he directed colleagues to look at. I will direct colleagues in the UK Government to look at that. Hats off to him for his attempt at signing the start of his speech. I thought that was a very brave move, and I thank him for his remarks.
The hon. Member for Erith and Thamesmead (Teresa Pearce) spoke very well about loneliness. I wonder whether the loneliness commission that our former colleague Jo Cox set up touched on the issue of deafness and its impact on loneliness; I would be interested to learn from those involved whether it did. The hon. Lady spoke about Jacob and the crowdfunding in her constituency for his cochlear implant. I do not know the details of his case, so it would be unfair for me to comment, but it sounds as though her community is showing incredible grace to that little boy. It would be wonderful to see him in the House when he has had his implant. She also raised the issue of the Access to Work cap again. My Department for Work and Pensions colleagues and I will write to her about her specific questions on numbers.
The hon. Member for West Lancashire spoke about her kidnap by the deaf community. Again, hers was a very emotional speech. I so wish she had done what she threatened to do and signed her entire speech, as long as she had given me a copy of it beforehand. I like to think I can cope, but I would not have coped with all of that. I thank her for her well made comments, especially about a single gateway. She is a member of the Health Committee, and I suspect that she is also a member of the all-party group, so perhaps she will make that suggestion to the new Minister for Disabled People, Health and Work and will talk about the cap on Access to Work when the group meets her. The hon. Lady also referred to invisible disability.
The hon. Member for Linlithgow and East Falkirk (Martyn Day) made points about the gender gap and EU law post-Brexit. They definitely do not fall within my remit, but I will write to him. We have the European Union (Withdrawal) Bill, or the repeal Bill as it is colloquially known, and in the past week or so, we have had a taste of the issues relating to animal rights. I have to say, as a Government MP and a Government Minister, I take slight umbrage with the suggestion—although not by the hon. Gentleman—that somehow we need the EU to have good rights relating to looking after animals in our country, let alone our citizens. I do not buy that for a minute. We will import that regulation through the Bill and then look at it as a sovereign Parliament and decide how we can improve on it. I am sure there are ways to do that. From what Members have said on the subject in this debate, and given the other Members who are interested, I somehow do not think that the issue will go unheard.
I will leave a few minutes for the hon. Member for Poplar and Limehouse to sum up. In conclusion, we have had a very interesting, honest debate. I hope I have been able to demonstrate to hon. Members that across my now expanding portfolio, we have a strong frame- work for supporting people with hearing loss through a set of quality and commissioning criteria—within a restricted budget, of course; that will always be the case. Setting the expectations for commissioners and providers is what we in the Department of Health are most interested in. The dedicated action plan on hearing loss is being spearheaded by NHS England, for which I am responsible, and the multi-agency approach is enshrined in the action plan.
We are doing a lot, but we can always do more. Some really good points have been made in today’s debate. Whether more people are watching today’s debate than “Pointless”, I do not know, but if more people watched debates such as this, they would have a far better opinion of Parliament than some of them do. We have had a really good debate and have covered a huge amount of ground. I very much thank hon. Members for their contributions, which have all been from the heart and incredibly well informed. I look forward to following up on many of the issues that have been raised.