Community Audiology

Thursday 18th December 2025 Westminster Hall

[Martin Vickers in the Chair]

15:00

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I beg to move,

That this House has considered community audiology.

It is an honour to serve under your chairmanship, Mr Vickers. I thank those who have joined us for the debate and the Front-Bench teams for giving up their time to put in the final shift of this sitting just before Christmas. I realise that I may not be on many people’s Christmas card lists after detaining them to the bitter end, but I appreciate their giving up their time and responding to this important debate. I am grateful to the Backbench Business Committee for securing this debate on community audiology, an under-discussed topic and a very important one in our communities.

Hearing and hearing loss are often the subject of stigma and shame, and sometimes light-hearted jokes in the media and film. Hearing loss is a serious issue—it is not a mild inconvenience—and it can be life-changing. It has a profound impact on the lives of millions of people across England and on the effective functioning of our health and care system more broadly.

Audiology services diagnose, treat and support people with hearing loss and deafness. They are critical to the quality of life and health of a significant proportion of constituents in all our communities. In 2024, 5.8% of people in England reported deafness and hearing loss. Although 94% of hearing loss is related to ageing, that is by no means the only patient group affected. In particular, I note that children’s audiology services are incredibly important to the life chances of children who are born deaf.

Untreated hearing loss has far-reaching consequences for physical and mental health, independence, employment and social participation. People with hearing loss are 2.5 times more likely to experience mental ill health related to social isolation and difficulties finding employment. Elderly people with hearing loss are 2.4 times more likely to experience falls, which in turn increases the risk of hospital admission, loss of independence and long-term care needs.

Untreated age-related hearing loss is one of the single largest modifiable risk factors related to dementia. Evidence suggests that treating adult-onset hearing loss between the ages of 45 and 65 reduces the incidence of dementia by 7%. In the context of an ageing population and the growing prevalence of dementia, that statistic alone should place hearing services firmly within our prevention agenda.

There are significant economic implications to poor service provision. The UK loses an estimated £25 billion a year in lost productivity and unemployment as a result of untreated hearing loss. On average, a person with hearing loss will see around £2,000 less a year than a non-disabled person, and 40% of people with hearing loss will retire early due to the challenges of communicating at work.

The demand for audiology services will only increase over the next few decades. The incidence of hearing loss increases by approximately one percentage point for every year of life. That means that at the age of 50, around 50% of people will experience some level of hearing loss, while 80% will by the age of 80. As our population ages, the pressure on audiology services will grow. As we embark on our mission to rebuild our NHS so that it is a first-class health service fit for the 21st century, it is crucial that we get our approach to audiology services right and in line with the Government’s three key shifts.

Audiology is exceptionally well suited to a nationally directed, community-based model for care, for five key reasons. First, most audiology services are low-risk procedures that can be easily carried out in community-based settings. Currently, 50% of national referrals to hospital ear, nose and throat teams are for uncomplicated non-surgical procedures such as earwax removal and age-related hearing loss. That is difficult to justify clinically or operationally, and sending those patients through complex hospital pathways places unnecessary pressure on ENT services, contributes to longer waiting times and is an inefficient use of specialist capacity. Instead, such procedures can be managed in a safe and effective way by audiologists in community settings.

Just this morning, as if perfectly set up for this debate, I met a constituent at the Christmas present-wrapping event for the fantastic ShopMobility charity in Uxbridge. This gentleman shared with me his wife’s experience in accessing audiology services in our community. His wife faces a more complex hearing issue—not something run of the mill that could be dealt with on the high street—that requires specialist intervention. She has been waiting around a year for a specialist appointment and follow-up at NHS ENT services to have the issue resolved. Shifting less complex cases out of secondary care settings would mean more capacity, more appointments and quicker health for my constituent’s wife, and many more people like her.

Secondly, delivering audiology services in community settings is far more cost-effective. Research by the University of York found that NHS adult audiology pathways delivered by community providers cost between 15% and 25% less than the same pathways delivered by an NHS hospital-based service. There is an obvious financial case for reform to a community-based model.

Thirdly, because audiology services are commissioned at a local level by integrated care boards and have in some cases already been transferred to community services, community audiology is not a new concept. We already have many good examples of good practice to build on, but unfortunately provision is variable and patchy. Thirty of the 42 ICBs in England already commission community-based services, with NHS services delivering assessment, hearing aid fitting, rehabilitation and long-term aftercare in primary care settings, community hospitals, outreach clinics and high street locations. Those services are delivered in partnership with GPs and private providers such as Specsavers. For example, the ICB in my constituency in north-west London commissions community audiology services, with self-referral across our whole area, providing a more consistent and accessible model than many parts of England have today.

Fourthly, delivering audiology in community settings assists the preventive healthcare agenda. People are not always forthcoming about seeking help for hearing loss. On average, it takes around seven to 10 years to acknowledge hearing loss and seek help, meaning that by the time most people present to services, the impact on their health and wellbeing can already be significant. Any barriers or difficulties in getting help can put people off asking for it, further delaying treatment and increasing their personal risk of things such as dementia, falls and mental health challenges, which I have outlined already.

Lastly, audiology provision in the community, especially models that enable patient self-referral without a GP appointment, are better for patients. They empower patients and support the early identification of hearing loss. They reduce travel time and other geographical barriers to access, particularly for older people and those with mobility issues. Community audiology services are particularly impactful for deaf children and their families. Children with hearing loss issues require more frequent appointments than adults—for example, to replace ear moulds for hearing aids as they grow—so community provision with appointments closer to home is particularly helpful for those families.

Taken together, the case for driving a quick shift to community-based audiology is clear. However, despite the opportunities, there remain several structural barriers to the rapid roll-out of community audiology services in every area. The recent Kingdon review of children’s audiology services set out many of the barriers in great detail. Its findings, which I would argue are relevant to audiology services in our country more generally, can be summarised in the words of the introduction: audiology is

“a ‘Cinderella’ service…often overlooked, undervalued and underfunded.”

The most significant issue is that the current system is fragmented and inconsistent, with a clear lack of national oversight. That is apparent from the fact that, astonishingly, the Kingdon review found that there is no national audiology lead in the Department of Health and Social Care, resulting a lack of ownership and accountability for the performance of services. It found that communication between the DHSC and NHS England on known service issues did not meet expected standards. I hope that the merging of the functions of NHS England and DHSC will be a key opportunity to resolve those challenges.

There is patchy coverage of audiology services throughout the country, with a significant postcode lottery of access. NHS audiology services are commissioned locally by ICBs, with tariffs set locally. Although local commissioning can support responsiveness to local needs, in this case it has resulted in wide variation in availability, quality and value for money. As I have said, only 30 of 42 ICBs commission adult community audiology services. In around half those areas, coverage is only partial, and in 12 ICBs no service is commissioned at all. In those areas, patients who are concerned about their hearing must first visit the GP and then be referred to a hospital-based service.

As I have set out, the lack of community provision leads to longer waits, poorer services and more expensive provision in some areas of England. NHS England’s 2023 guidance encouraged direct access and self-referral to audiology services to reduce pressures on GPs, yet evidently not all ICBs have implemented that guidance. Local commissioning and tariff setting has also created substantial inconsistencies in tariffs. In some areas, audiology service tariffs have been set below the cost of delivering care, which has forced some providers to reduce and compromise service quality by, for example, cutting follow-up appointments, outcome measurement and rehabilitation support.

In some areas, local commissioning within limited financial envelopes has resulted in activity caps based on financial envelopes rather than patient need, resulting in predictable waiting list growth. Some services have reportedly been asked to reduce throughput or pause the issuing of hearing aids entirely in order to remain within their contractual limits. This practice undermines the principle of care based on clinical needs and risks storing up greater costs for the future.

The lack of national oversight has produced issues with quality assurance. While many independent and third sector providers deliver high-quality services, there is clearly variation in quality of service, and currently no mandatory system-wide quality assurance requirement for all NHS-funded audiology provision. That lack of oversight has also led to certain services falling through the gaps of NHS provision. The starkest example is earwax removal, about which I am sure many of us will have had emails from our constituents. It is perhaps not the sexiest of issues, and not one that we often like to talk about. I will hold my hand up: I have had earwax removal several times—historically from my GP, and more recently in private Specsavers-based settings—so I can speak at first hand about the impact of these services, or the lack of them.

Historically, wax removal was carried out by GPs and nurses in GP practices. Following a change to the GP contract in 2012, it was no longer designated as a core service, and now, over a decade later, the majority of GP practices no longer provide it. As a result, patients who cannot self-care or self-fund their treatment in a private setting often have no option other than to refer themselves to specialist hospital ENT services when the problem gets much worse, unless they live in one of the very small number of ICB areas that do still commission the service as part of the community audiology pathway. Wax removal is a simple, basic procedure, and it is nonsensical that it is not always delivered in the community.

Data collection and oversight is also extremely poor. NHS England recently decided to stop referral-to-treatment waiting time reporting for audiology services, which has removed visibility of the full patient pathway. Diagnostic data suggests that audiology is now a poorly performing diagnostic service, with over 70,000 people waiting and some regions experiencing delays of more than 40 weeks. Without consistent data, commissioners and providers, and policymakers such as us, simply cannot understand where pressures are greatest and where intervention is needed most.

Like many areas of community services, audiology services are also seeing significant workforce planning issues. There are fewer than 10,000 audiologists and hearing therapists in the UK, and work by the National Deaf Children’s Society and the British Academy of Audiology found that 48% of audiology services have seen a decline in staffing since 2019, equating to an overall reduction of around 8% of the total workforce.

The Kingdon review described the audiology workforce as having been “neglected for years”, with low status, poor professional representation, limited governance and insufficient investment in research and training and development. Coherent workforce planning could be facilitated by the introduction of a single professional register for audiologists, as well as a much more consistent approach to professional development, training pathways and retention measures. This is incredibly important given the predicted increase in demand for services, and I hope that audiology services, and community and primary care workforce issues more generally, will feature centrally in the Government’s promised new workforce plan, as we seek to shift activity away from secondary care towards primary and community-based care.

I welcome the steps the Government have taken to move forward improvements in audiology services. The commissioning and publication of the Kingdon review was a very helpful step. The 10-year health plan for England, published in July, committed to enabling self-referral to clinical audiology, using the NHS app where appropriate, which is welcome. NHS England is supporting providers and ICBs to improve audiology services through capital investment, upgrading audiology facilities, expanding testing capacity via community diagnostic centres, and direct support through the national audiology improvement collaborative.

All those developments are welcome, but clearly there is much more to do. We now need a coherent national framework that gives audiology the strategic attention it deserves. That should include, first, a national commissioning framework for audiology services, including standardised tariffs and activity planning to reduce unwarranted variation and ensure that services are commissioned on the basis of patient need rather than short-term financial constraints locally.

Secondly, the framework should mandate system-wide quality assurance for all NHS-funded audiology services, regardless of provider, building on existing frameworks. Thirdly, it should require a clear national direction on the movement of audiology services into community and neighbourhood health models, setting out how services should integrate with primary care, ENT, social care and broader support services. Fourthly, it should require the reinstatement of referral-to-treatment waiting time reporting for audiology, so that performance is transparent and improvement efforts can be properly targeted.

Fifthly, the framework should require sustained investment in the audiology workforce, including for expanded training places, improved retention measures and the implementation of the Kingdon review’s recommendations on professional registration and governance. Finally, it should require action to ensure equitable access to core interventions such as earwax removal, so that access to basic hearing care is not determined by postcode or ability to pay.

Audiology services may not often feature prominently in political debate, but they matter deeply to millions of people. They matter to older people striving to remain independent, to working-age adults seeking to stay in employment, and to children, whose language, development and life chances depend on early and effective intervention. Community audiology offers a practical evidence-based opportunity to improve access, quality and value for money, but realising this opportunity will require national leadership, clear standards and some sustained investment.

I thank all Members and the Front-Bench teams for being here. I hope the Minister can address the issues in his response. If we are serious about prevention, reducing health inequalities and delivering care closer to home, then community audiology must be part of the conversation. I hope that, as we do so often in this place, we can all say “Hear, hear!”, not only as a mark of agreement, but as a promise of a better future for hearing services in every part of our country.

[Hon. Members]

Hear, hear!

15:16

[Sir Edward Leigh (Gainsborough) (Con)]

I congratulate the hon. Member for Uxbridge and South Ruislip (Danny Beales) on moving this timely motion. I declare an interest: I am someone who suffers from hearing loss—it is good to be honest about these things. I recently found a picture of myself in uniform in the pouring rain, looking very miserable in Germany or on Salisbury plain, leaning against a 25-pounder. I can assure Members that those guns went off next to my ear on many occasions, and it is a very loud bang indeed.

I am not alone in suffering from some hearing loss. As the hon. Gentleman made clear, if we group together deafness, hearing loss and tinnitus, some 18 million people in the UK are affected by hearing conditions. Of those among us who are 55 or over, more than half suffer from hearing loss, as he said. Of those of us who are 70 and older—Mr Vickers, you and I were born just weeks apart—over 80% have some form of hearing loss. Some 2.4 million adults across Britain have hearing loss that is severe enough for them to struggle with conversational speech in some situations.

We all know that an ounce of prevention is worth a pound of cure. That is even more true in medicine than in any other walk of life. I am one of 2 million people in the UK who use a hearing aid. People should not be ashamed of using a hearing aid. People are not ashamed of wearing glasses—the Minister, Mr Vickers, and the distinguished consultant from Suffolk, the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley), are all wearing glasses. It is a fact of life, and we should support people.

The British Academy of Audiology estimates that there are 6.7 million people who could benefit from a hearing aid but do not currently use one. The impact is not limited to wives, irritated that we have not heard them—although I must admit that if someone is known in the family to have hearing loss, it is very convenient. I am frequently ticked off by my wife because I am generally completely useless, and sometimes I pretend I have not heard her, so there are some benefits.

[The Minister for Care (Stephen Kinnock)]

The right hon. Gentleman is busted now.

[Sir Edward Leigh]

At the risk of giving in to economic reductionism, there is a significant impact on the economy. The Royal National Institute for Deaf People has estimated that untreated hearing loss costs the UK economy around £30 billion per year in lost productivity. Adults of working age with hearing loss have an employment rate of 65%, compared with 79% for those without any disabilities. Hearing loss has a social cost as well, as it has an impact on daily life and often increases isolation. Too often, we are embarrassed by hearing loss when we should be tackling it head on.

Another problem is a lack of audiologists. Unwisely, the Government have maintained the cap on the number of people allowed to study medicine—a restrictive measure that the doctors’ unions cling to regressively. The first priority should be the health of the public. We should allow anyone who meets the high standards that we expect of those studying medicine to do so.

Instead, the doctors’ unions ensure there is a lack of domestic supply to protect their bargaining position, but that means we are forced to make up the shortfall by importing doctors from other countries, often less developed ones. Many countries, not just fully developed ones, have high standards of medical education. It seems to me, and to many others, morally dubious for the NHS to pick the cream of doctors from any developing country and bring them here. Their diligence, training and expertise are much needed in their home countries. Meanwhile, we have excellent people here who cannot get into medical school—not because they are not good enough, but because the numbers are capped.

The shortfall in audiology is yet another reason why we need to address this issue. We have over 3,000 registered audiologists working in the UK, across the NHS, the private sector and educational settings. Figures from the British Academy of Audiology show that 48% of services have reported reduced staff, with an overall decline of 8% in the audiology workforce. Nearly one in 10 clinical posts in audiology are currently vacant, and 65% of audiology services have at least one vacancy. Those shortages exist across multiple salary bands, from junior to senior clinicians.

I am not blaming this Government, by the way; I am not being party political. This problem is the fault of successive Governments and Health Secretaries, who have failed to address it. Back in 2006, the Royal National Institute for Deaf People pointed out in evidence to the Health Committee:

“A recent NHS workforce project has suggested an additional 1,700 qualified audiologists are required to cope with current pressure. This could take between 10 and 15 years to realise under the current training programmes.”

That was back in 2006, so what has happened since then? It will not surprise the experienced observer that not enough action was taken. Hearing loss is one of the most prevalent long-term conditions in England, yet it is often treated as a low-priority service. If we treated it as a core part of prevention and independence, the rewards would be innumerable. As I said, an ounce of prevention is worth a pound of cure.

Demand for audiology services is rising, and the International Longevity Centre estimates that by 2031, one in five Britons will have hearing loss. There is at least increasing public awareness, but with an ageing population, the demand for audiology services is rising. That puts additional pressure on the workforce and on service capacity. Community audiology should not be a marginal service. It is a preventive intervention with clear implications for the wellbeing of individuals and families, economic productivity and long-term public spending. Delivering audiology close to home is ideal, particularly for older patients and those managing long-term conditions.

The current model relies heavily on local commissioning decisions. There is wide variation in access, as well as in the scope and quality of provision across England. Patients in some areas benefit from straightforward self-referral and timely community services, while others face longer waits or unnecessary hospital referrals. I suspect that the service in London and other big cities is better than that in our home county of Lincolnshire, Mr Vickers.

We need to improve the way we collect data on audiology services, so that we can evaluate their impact across the country. Good data will help us to focus on outcomes, as any reform should. National minimum service standards would provide clarity without imposing uniform delivery models. We should preserve local flexibility while ensuring that patients know what level of service they are entitled to expect. Community audiology should be integrated into broader prevention and healthy ageing strategies.

Hearing care supports people to remain economically active and socially connected for longer. That is immensely central to maintaining human dignity as we all get older. Early intervention reduces downstream costs in social care and mental health services. The social and economic impact is huge. There is much we can do now that will produce worthwhile results, so we need action from the Minister.

15:25

[Richard Foord (Honiton and Sidmouth) (LD)]

It is a pleasure to serve with you in the Chair, Mr Vickers. I am grateful to the hon. Member for Uxbridge and South Ruislip (Danny Beales) for choosing this as a subject for debate.

It was fascinating to hear from the Father of the House about his time in the Honourable Artillery Company, listening to the guns and then perhaps regretting it in later years. It reminds us of our responsibility in this House to try to prevent problems that may emerge later. Last weekend, I was reading about a former colleague of mine, Lieutenant Colonel Rob Page, who has suffered 20% hearing loss off the back of his time testing the Ajax vehicle. Plainly, that is something we have to watch out for.

This debate is about community audiology. In my Devon constituency, I represent people who care a great deal about hearing health. Honiton and Sidmouth has the sixth oldest constituents in the country by demographics. Local health data shows that 7.3% of residents in the Devon ICB area report hearing loss or deafness. That compares with an average in England of 5.8%.

In an ageing population, this is about the older age profile of all of our communities. In my constituency the median age is 57, so hearing loss is very common and hearing care is essential. Johns Hopkins University found that people with moderate hearing impairment are more than twice as likely to experience a fall as those without hearing loss. Falls in older people often lead to hospital admissions and then to a significant loss of independence.

The Health Secretary has characterised the plans for NHS reform as being partly about a shift from sickness to prevention and from hospital to communities. Plainly, community audiology will have to sit at the heart of this. In Devon, community audiology has been complicated by some major changes in provider arrangements. Until March this year, Chime Social Enterprise delivered NHS audiology services and routine community audiology. Chime had its challenges, but it had a local presence, including in a lot of towns that I represent. It had drop-in clinics for people who needed urgent repairs or had urgent issues. However, from 1 April 2025, NHS Devon integrated care board commissioned several new providers in place of Chime for routine and specialist audiology, and that changeover has caused a lot of problems.

One elderly constituent, who has relied on hearing aids for more than 25 years, told me that she had to wait from June until September before she was able to see her usual audiologist. When she finally got to her appointment in Sidmouth, she discovered that the new provider had no access to her medical records, and she was told that she would have to come back in November to have new hearing aids fitted and supplied. Something that should not have taken very long at all took a total of five months. That was not just five months of inconvenience waiting for an appointment; it was five months of struggling to communicate with the rest of the world. I wrote to NHS Devon after being inundated by similar reports, and I received a reply to my letter of 16 June saying that the changeover was happening as fast as NHS Devon could make it happen.

Although waiting times appear to be improving, this disruption is not unique to Devon and it reflects wider pressures across the community. Across NHS community audiology in England, 38% of people were waiting six weeks or more for audiology appointments. That is set against the fact that the national hearing loss charity the RNID reports that about 70% of people who go private receive hearing aids or support within two weeks. Plainly, we are seeing that when community audiology breaks down, patients wait longer for appointments, continuity of care is lost, and those who cannot afford to go private get left behind.

That is not supporting the transition—from hospital to community, and from treatment to prevention—that the Government want. If the NHS is truly to prevent hearing loss in the community, community audiology must work for patients every time, and that includes in rural and coastal areas such as the one I represent.

15:29

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) for securing this interesting debate, and I declare a series of interests. I am an ear, nose and throat surgeon, so I have been interested in audiology for 40 years. In this place, I chair the deafness all-party parliamentary group. Until I came here, I was the chair of the Norfolk Deaf Association, which is also called Hear for Norfolk, and I will say a bit about that as we go on. I have worked overseas dealing with patients with hearing loss, and I have been a specialist ear surgeon for 30 years or so. Audiology has really been much of my life.

As many Members have already said, deafness is a hugely common problem and is often much neglected. The statistics that have been cited regarding the percentage of elderly people who begin to develop hearing loss are quite familiar to me. What happens is that couples age together, but they might not always appreciate that fact. There is the story of the man who decides to test his wife’s hearing. He comes up behind her and says, “Mavis?” There is no response, so he says, “Mavis”, then “Mavis!”. She turns around and says, “For the third time, what is it that you want?” It is very familiar to me that many elderly people have hearing loss.

As I think has already been said today, about 2 million people in the country use hearing aids. There are probably about 6 million people in the country who would benefit from a hearing aid and probably about another 2 million hearing aids that are in drawers; they have been distributed to people, but are simply not used. Some people have a lot of hearing aids. They come in and say, “I’ve got all these hearing aids. None of them are any use, doctor.”

The story of NHS hearing aids is that we started with great big cream-coloured plastic boxes with little plaited wires that led to earphones; some of us will remember children at school who had those. Then, of course, the so-called BE hearing aids came later. When I was a young ENT surgeon, I never knew what “BE” stood for. A few years later, somebody told me that it just stood for “behind the ear”. Those were analogue hearing aids and they were quite good. They were extremely inexpensive and were distributed in their millions in NHS hospitals, which is how we ran hearing aid services.

Then, about 25 years ago, digital hearing aids were invented. They were not immediately available in NHS hospital clinics, because they were a little more expensive, so they started to be distributed by private hearing aid providers that sprung up all over the place. Members will know that in many high streets there is an audiology service and in the window there will be one hearing aid in a little box on a felt cushion. Curiously, hardly anybody ever goes in and out of those services. The reason is that those companies do not need to sell many hearing aids to stay in business because of the difference in cost. The digital hearing aids provided by those private providers often cost in the thousands, so they need to sell a hearing aid only once or twice a week to stay in business. At first, those hearing aids were a bit better than the ones we could provide in the hospitals.

Some time later, we began to distribute digital hearing aids through the NHS, which was brilliant. People would come to me and ask, “Do you think I should get a private hearing aid?”, and I would say something like, “Well, you can get a private hearing aid, but it is a bit like a hi-fi.” Someone can go to Argos and get a hi-fi or they can go to Bang & Olufsen and get a hi-fi. There is a big difference in price and they do actually sound quite different. I would say to people, “The hearing aids that we can give you are like John Lewis hearing aids; they are pretty good, and they are good enough for most people. I don’t think you should go and spend £4,000 on two private hearing aids. You should have the hearing aids that I can give you for nothing in my NHS clinic, because most people will be very happy with that.”

That was the model we used until a particular Government came along—I cannot remember which one—and decided that we ought to have something called the “any qualified provider”, or AQP, system. Suddenly, all sorts of people could provide hearing aids willy-nilly. We had a different acronym for it: “any willing provider”. Anyone who wanted to provide hearing aids could do so because, as has been said, there was not a particularly close supervisory mechanism. I have a feeling that anybody could set themselves up as a hearing aid provider, if they wanted to. We had this completely variable system in which some people spent large amounts of money on hearing aids that they kept in a drawer, and some people received hearing aids for nothing from hospital services.

That was how we went on, until somebody mentioned earwax. As some people may remember, general practices used to remove earwax with large stainless steel syringes that had a spout on the end. Those procedures were done by nurses until about 2012 when it stopped being part of the GP contract. There was a problem with the syringe: the little stainless steel nozzle on its end could become a bit worn, so it would not be completely connected. As a result, when somebody pushed the syringe, the stainless steel nozzle could fly off into the ear. I have repaired numerous eardrums over the years that had been smashed by syringing, so that system was not completely without its problems. Of course, we had aural care nurses in hospitals looking after patients and coming to take out their earwax, or if a patient had undergone an ear operation, the nurse would have to clean out their mastoid cavities.

We then, however, began to see all sorts of community providers of earwax services, sometimes set up by people who had been nurses in ear clinics, and sometimes set up by somebody from another occupation—they could have been a Member of Parliament who decided that they were now going to do earwax removal. There was a fee to be gathered from this, and some people did fairly well from removing earwax, but the provision was of very variable quality.

I would like to talk about Hear for Norfolk, or the Norfolk Deaf Association, which I chaired for quite a few years before I came here. It is a community-based audiology service that employs qualified nurses who have previously worked in NHS hospitals, and they perform what we call aural care, which includes removing earwax. People can just turn up to have that done; if they are referred by their GP, it is free on the NHS as there is a contract, or they can pay £50. We have vans that go around the district into nursing homes and small villages to do that work.

We now have a contract for hearing aid provision from the NHS, meaning that our not-for-profit charity provides thousands of hearing aids and treats thousands of patients in a community-based setting. I think that such a model could be developed and rolled out around the country so we have community-based, county-wide, not-for-profit aural care services that provide hearing aids.

I am not confident about simply distributing the contracts for hearing aid provision to a whole lot of private providers—Specsavers is one but there are many others—because the quality of their services is variable, and there will always be an incentive to provide private hearing aids. If someone walks into a service, they will be told, “Well, you can have this NHS hearing aid, but you know what? You could have this private one.”

[Sir Edward Leigh]

The hon. Gentleman is giving an absolutely brilliant speech. It is such a pleasure to hear a Member of Parliament speaking from direct, personal experience. I want to emphasise one important point that might come out of this debate: a lot of people are paying a lot of money for private hearing aids, but I know from personal experience that, nowadays, NHS hearing aids are perfectly satisfactory.

[Peter Prinsley]

I could not agree more, given the number of people who have come to me with handfuls of hearing aids on which they have spent thousands of pounds, telling me that they are just not working—and there is no proper follow-up for many of those people.

The issue with a hearing aid is that it needs to be looked after: it has a mould, it has batteries and it needs cleaning, so there needs to be an arrangement for follow-up. That is the sort of thing that an organisation such as the Norfolk Deaf Association, or Hear for Norfolk, is able to provide—it knows that that needs to happen. We need to be cautious about the quality of community audiology provision. We must not think that just because we are distributing it to respected private providers such as Specsavers, we are necessarily doing the right thing.

It has rightly been said that there is no national lead for audiology. Audiology is in a pickle, and it would be brilliant to get a proper national lead for audiology in the Department of Health and Social Care. There are issues with shortages of audiologists, but when questionnaires ask which healthcare professionals—or even which professionals—have the happiest lives, audiologists come out right at the top. Audiology is a particularly lovely occupation because people come in deaf and you send them out hearing. You hardly ever make them worse; it is not like going to the dentist, where it hurts. There is really nothing not to like about doing audiology, and it is a very interesting career, so I would like us to think of ways of encouraging people into it.

There is a bit of a confusion between medical practitioners and audiologists. The right hon. Member for Gainsborough (Sir Edward Leigh) referred to the issues relating to how we recruit medical practitioners from overseas. I am not aware that we are recruiting large numbers of audiologists from overseas; I actually think that we are not, although we did have audiologists who came from the EU when we were members of it. We can train enough of our own audiologists, but we need to get on and organise it.

I could talk about this for the rest of the day but it will be Christmas soon, so I shall sit down. I thank my hon. Friend the Member for Uxbridge and South Ruislip again for securing this important debate.

15:43

[Dr Danny Chambers (Winchester) (LD)]

It is a pleasure to serve under your chairship, Mr Vickers. This is an important debate, secured by the hon. Member for Uxbridge and South Ruislip (Danny Beales), but it is quite something to have to follow an eminent and experienced ENT surgeon, the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley), when speaking about hearing and hearing loss—especially as I am just a rudimentary vet.

It is quite common that people bring in a dog that they assume has hearing loss because it can no longer hear its name being called in the park, yet for some reason it can still hear a treat packet or a fridge being opened in another room. On comparative anatomy, the hon. Member for Bury St Edmunds and Stowmarket may be interested to hear that one reason why up to 20% of a caseload in a day of treating small animals can be on ear-related issues is that in humans the ear canal goes straight to the eardrum whereas in dogs it bends around 90° before it gets to the eardrum. Around that corner it is often quite warm and moist, and a lot of bacteria and yeast grow in those conditions.

[Peter Prinsley]

I am very interested in the story of dogs and the shape of a dog’s ear canal; that is such a helpful explanation. I was often brought dogs, particularly spaniels with big floppy ears, who had ear infections and blockages, and I was always puzzled why it was that the dogs got into such difficulties. The hon. Gentleman’s explanation of the right angle at the bottom of the ear canal is so helpful and I thank him for it.

[Dr Chambers]

I am honoured to have educated an ENT surgeon. Spaniels do have worse ear problems, given that there is a lack of airflow, and one thing that vets can get experienced at is taking a swab so that we are not using unnecessary antibiotics or inappropriate antibiotics. With a bit of experience, it is fairly easy to smell the difference between Malassezia yeast, pseudomonas bacterial infection or streptococcus intermedius—to anyone who thinks being a vet is glamorous, I say, “Spend a day sniffing ears to determine what type of microbes are down there, and it will change your mind.”

It is very interesting that many Members spoke today about the impact of hearing loss on dementia. We know that dementia is multifactorial—there is no single cause—but certainly my father had hearing loss for a long time, and he developed dementia. Hearing loss certainly affected his quality of life, dementia aside. He lost the confidence to go out to socialise and barely left the farm unless he had to. We are pretty sure that a significant factor in that was that he felt he could not hear what other people were saying. He could not perform business at the market as he used to, because markets are very noisy places.

The Father of the House touched on the fact that one in three adults have either deafness, tinnitus or some other type of hearing issue. What surprised me was that only 38% of people who suspect that they have hearing loss themselves have contacted a professional about it. I read that stat and was quite surprised, but I then realised that for years my partner Emma and other family members have often said, “Why do you have the TV so loud?”. I have also often noticed in a pub everyone else is talking, and I find it really hard to hear the conversation over any external noise, yet I have never gone along and had a hearing test. Quite clearly, I do not hear as well as everyone else in my vicinity, so I should probably get one. That could be a new year’s resolution for me—to go and work out whether I actually have some kind of hearing issues as well.

I also note the weight given to the importance of community audiology, especially when such a high percentage of hearing loss is age-related. Those people have no need to go to a hospital to get the initial assessment, and community audiology could free up hospital time for children and other people with more acute hearing issues that need to be investigated. Audiology is one of the worst performing diagnostic services in the NHS for speed of assessment, with 40% of patients waiting more than six weeks simply for the initial assessment. That is one reason respondents to the British and Irish Hearing Instrument Manufacturers Association are advocating for open self-referral and expanded community clinics simply to minimise those delays. Delivering audiology services in the community costs 15 to 20% less than from a hospital, so it is an economically sensible model as well.

We often call for more community-based services for a whole variety of medical issues to keep costs down. It should be the default for most people with age-related hearing loss. We also urge the Government to consider trialling hearing tests as part of routine health checks for people over 70 and at-risk groups and to investigate how best to support everyone, from GP surgeries to high street pharmacists and opticians, to deliver free earwax removal. They are already being successfully run by some GP practices with positive impacts on health outcomes, and the cost can be small, especially where GPs co-ordinate to pay for a service that covers a large area.

[Sir Edward Leigh]

The hon. Gentleman makes a good point that we often hear about national screening programmes. It has just occurred to me that if everybody over the age of 70 was sent a text message through the NHS, summoning them into a screening programme, we could make huge advances in this area, particularly with things such as dementia—because, as he made clear, many people are either embarrassed by hearing loss, or not aware that they have it.

[Dr Chambers]

I completely agree. As we approach the busiest and loudest time of the year and every shop and pub has music playing, which is fun for most people, it is a good time to urge people to go for a hearing test in the new year, as I will be doing. We urge the Government to look at supporting community-based services so that everyone can get the hearing assessment they need. People need information to be able to act, and if someone does not know their hearing status, they will not know what other problems they will be dealing with in the future.

15:50

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers, and I wish you and your team a merry Christmas. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for inadvertently creating what seems like a medical symposium; I feel as if I am back at one of my Christmas grand rounds—they often used to pick something a little bit strange and wacky to debate. I did not quite expect to be talking about spaniels’ ear canals, but I enjoyed the flashback none the less.

The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) rightly talked about couples. When I was a GP, I saw couples become yin and yang, supporting each other on the basis of who had the hearing loss, who had the brains and who had the dexterity. If one of those problems is not sorted, there can be real impacts for the others. We should consider that when we deal with patients. The hon. Gentleman’s point about drawers of waste was a personal hobby horse of mine too—though it was not hearing aids, but often medication brought back to me, or seeing thousands of bandages or eye drops left over when I went on home visits, for example. That is a really important point and the NHS is not very good at picking up on it.

I thank the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), for raising the issue of stigma. My grandfather was particularly bad and stubbornly did not want to get a hearing aid, and even when he did get it, he would not wear it. My right hon. Friend also joked about his wife not hearing him, which reminded me of “Captain Corelli’s Mandolin”; at the start of the film, the pea is taken out of the ear, but at the end, because of all the nagging, he is desperate to get the pea reinserted.

My right hon. Friend also raised the issue of workforce, which is incredibly important when it comes to trying to solve some of these problems. The hon. Member for Uxbridge and South Ruislip set out clearly and coherently both the landscape and where we find ourselves. That is really important because, when people think about care delivered close to home, hearing loss services are among some of the most visible examples on the high street and in our community settings across the country. I visited the Specsavers on Hinckley’s high street, as well as the pharmacy in Newbold Verdon, only a couple of months ago to see what they provide.

There is a real opportunity to bring care towards people, which makes high streets a good bellwether for this Government’s ambition on prevention and community care and how that is being translated into practice. There are three issues I would like to press the Minister on. The first is the funding pressures on the ICBs, the second is access and self-referral, and the third is national oversight and data.

On access and self-referral, under previous NHS operational planning guidance, ICBs were asked to increase direct access and self-referrals into audiology services. That was a good move; it meant that people concerned about their hearing could go straight to specialist care without needing to see a GP first. In many areas, that has been a success. However, as we heard during the debate, 12 ICBs that commission hearing loss services still require a GP referral. That adds delays for patients and places unnecessary pressure on general practice, not necessarily for any clinical benefit. Against that backdrop, it is a little disappointing to see that self-referral was not included in the most recent operational planning guidance for 2025-26, nor in the medium-term planning framework. The question is why. Would the Minister explain why self-referrals seem to have been deprioritised, and what concrete steps the Government are taking to ensure that access to audiology does not depend simply on where someone lives?

On funding pressures and core services, Members have rightly highlighted the significant variation in access to routine audiology services, particularly earwax removal. In too many parts of the country, people are either being pushed back to the ENT departments or told to pay privately. I am glad that we have an eminent surgeon in the Chamber, the hon. Member for Bury St Edmunds and Stowmarket; from a GP’s perspective, I understand why some were reluctant to go back to having their ears syringed and I often dealt with complaints about why it was not suitable, as suction is the gold standard.

The question is how we provide that in a way that is deliverable to the community and provides to the patients, but is also at least cost-neutral for primary or secondary care. There is a conundrum there. That situation will be made worse, as the Father of the House pointed out, by our ageing population. When ICBs are under pressure and their budgets are changing—they are being cut by 50%—how do we ensure that that it is deliverable? That poses the question of how sustainable it is to place the responsibility of the full range of audiology services on ICBs, considering they are under constraints, and how will the Government square that circle. There is also the opportunity of public-private partnerships and neighbourhood centres to help to deliver audiology services. That could come as sites or services. I would be grateful if the Minister could set out what his vision is in this space, considering we are trying to take a leftwards shift.

There are also opportunities for new thinking. As I mentioned, I went to see a pharmacist. What supports have been put in place for new providers to come in? Pharmacists seem keen to be able to take on more services, and they often have sites directly in the heart of our communities—the closest place to our residents. Is there some consideration of what can be done to innovate in that space?

On data, oversight and accountability, one of the most striking features of audiology is how difficult it is to assess the performance nationally. The Government were right to set out their ambition to meet the NHS standard that 92% of people should wait no longer than 18 weeks from referral to treatment, and in most specialties we can clearly see how the system is performing against that ambition. However, in audiology it is harder, especially as the referral-to-treatment waiting time data, which was paused during the pandemic for understandable reasons, has since been retired by NHS England.

Looking ahead, given that the Government have confirmed their intention to bring forward legislation to abolish NHS England, with the statutory functions being taken into the system, will the Minister consider looking again at reinstating the referral-to-treatment waiting time data for direct audiology as a way to monitor the leftward shift that the Government are pushing for? If so, will that be done at ICB level or under the Department of Health and Social Care?

I would be grateful if the Minister could clarify two points. First, when does the Government expect to introduce the legislation in 2026? Secondly, it would be helpful to understand when we can expect the workforce plan: we were told that it was coming in the summer, then the autumn and, now that we are on the last day of business before Christmas, I expect it is coming in the new year. Knowing when that plan is coming, and how audiology will play a part in that, is really important.

Given the Kingdon review only came forward in November, it is unfair of me to ask whether the Government have fully assessed it yet. The review had 12 recommendations and also pointed out the oversight, and there is a question about how that will be resolved. With all the changes to ICBs, NHS England and the Kingdon review, I would be grateful to know when we will likely hear whether all recommendations have been accepted and will be resolved.

Audiology may not always attract attention in this House, but it is a vital part of our community healthcare and a real test of the Government’s commitment to prevention and access. I hope the Minister can provide clarity on the questions I have asked today. I wish you, Mr Vickers, your team, your colleagues, everyone in this House and my constituents a very merry Christmas.

15:58

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers. I start by thanking my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) and congratulating him on securing this important debate. Having now been in the same room as a specialist in ear, nose and throat, a former GP and a vet, I am not sure that I am entirely qualified, and I approach this debate with some trepidation. I certainly enjoyed the debate and, as the Father of the House rightly said, it was a privilege to be able to hear some of the insights, direct experience and expertise of hon. Friends and Members.

My hon. Friend the Member for Uxbridge and South Ruislip has also been doing a huge amount of good work in promoting the flu vaccine ahead of winter, in his constituency and more widely, and I pay tribute to him for that. It was a pleasure to visit his constituency a few weeks ago, where I met the incredible team at the Pembroke centre in Ruislip Manor to hear about how they are delivering, designing and developing their thoughts about neighbourhood health hubs and the neighbourhood health service, which will be a pivotal part of our 10-year plan.

The Royal National Institute for Deaf People estimates that one in five people in the UK—almost 12 million adults—are deaf, have hearing loss or experience tinnitus, and by 2035 that figure is projected to rise to over 14 million. For people with cognitive disabilities, hearing loss can have a real impact on their quality of life, causing confusion for people with dementia, making communication and social interaction more difficult and increasing loneliness and isolation.

That is why our community audiology services are so important. They represent a comprehensive range of hearing care delivered in local, accessible settings, such as GP surgeries, community clinics and community diagnostic centres. They help people of all ages, offering assessments, hearing aid fittings and support for those with tinnitus and balance issues. They advise on equipment such as amplified telephones and alerting devices, while working alongside occupational therapists to support people to stay independent. They form part of a wider team with speech, language and other community services, acute care, and the ear, nose and throat department for issues that cannot be managed in the community.

Community audiology services face challenges, particularly on waiting lists and inequality of provision. Members across the Chamber raised some of those points. The Father of the House rightly pointed out that there are 6.7 million people who should use a hearing aid but do not. We must overcome the stigma associated with hearing loss.

The hon. Member for Honiton and Sidmouth (Richard Foord) was right to talk about the connection between hearing loss and the propensity for falls. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) shared his tremendous expertise as an ear, nose and throat surgeon, and I thank him for his insights about the Hear for Norfolk project, which is a very interesting model indeed. Perhaps we can follow up on it in the new year.

The hon. Member for Winchester (Dr Chambers) gave a remarkable exposition on hearing loss in dogs—I have to say that I did not have that on my bingo card for this afternoon—from which we all learned a tremendous amount. He also made a number of important points about hearing loss in humans, and we absolutely take them on board.

The hon. Member for Hinckley and Bosworth (Dr Evans) rattled off a number of questions for me, and I desperately tried keep track of them. I got some of them and did not get others, so I will happily write to him on the points that I am unable to address now. He raised an important point about self-referral, which of course depends on local commissioning arrangements. There is inequality and unwarranted variation in the ability to self-refer. We want more self-referral. We think there are opportunities in upgrading the functionality of the NHS app. Our objective is absolutely to be able to do this without having to go through a GP. There are some technology-related solutions, but I want to assure him that there is no conscious decision from the Government to deprioritise self-referral; I just think that there are some variations.

The old chestnut that we are constantly trying to crack is around devolving to ICBs the power and agency that they should have because they are closest to the health needs of their population, while ensuring that they are clear about the outcomes, frameworks and standards that we expect. We honestly hold our hands up and say that we have not got that right in all cases, but we are committed to self-referral as a principle and as a really important part of the shift from hospital to community.

On ICB budgets, we have secured £6 billion through the spending review process for capital upgrades. A lot of that will help us to ramp up what we are doing on community diagnostics. That is one way to square the circle around the investment that we need on the ground for ICBs to be able to do more in terms of the services they provide by improving the equipment, the kit and the technology they have. Part of the answer to the hon. Member for Hinckley and Bosworth’s question relates to capital investment really helping to boost the services provided.

The workforce plan is coming in the spring of 2026. I absolutely hear what the hon. Member says about the need to move forward on that. It has been a complex process. Obviously some of the changes and restructuring around what we are doing on NHS England have also had an impact on the process of putting the workforce plan together, but I am reliably informed that that will be in the spring of 2026.

Timely access and effective support to services can make all the difference to someone’s quality of life, wellbeing and independence. As part of our effort to shift care from hospital to home, this Government want to support people to live independently in the community, and community audiology will play an essential part in making that happen. Community audiology is commissioned locally by integrated care boards. Funding is allocated to ICBs by NHS England. Each ICB commissions the services it needs for its local area, taking into account its annual budget, planning guidance and the wider needs of the people that it serves.

This year, my right hon. Friend the Chancellor confirmed the Government’s commitment to getting our NHS back on its feet and fit for the future, with day-to-day spending increasing by £29 billion in real terms over the next five years. By the end of this Parliament, the NHS resource budget will reach £226 billion. That funding will support the growing demand for community health services, including audiology. It will help integrated care boards to expand diagnostic capacity, invest in local estates and equipment, and sustain the workforce needed to deliver high quality hearing care for patients of all ages. For the first time, we have published an overview of the core community health services, which include audiology, for ICBs to consider when planning for their local populations and commissioning processes.

Our medium-term planning framework for the next financial years sets out our ambition to bring waiting times over 18 weeks down, develop plans to bring waits over 52 weeks to zero, and to increase capacity to meet growth in demand, which is expected to be around 3% nationally every year. We are asking systems to seek every opportunity to improve productivity and get care closer to home, from getting teams the latest digital tools and equipment they need so they can connect remotely to health systems and patients, to expanding point-of-care testing in the community. Systems are also asked to ensure that all providers in acute, community and mental health sectors are onboarded to the NHS federated data platform and use its core products.

Our 10-year health plan sets out how we would make the shift from analogue to digital by making the NHS app the digital front door to services. We will make it easier for patients to access audiology services through self-referral. This will transform the working lives of GPs, letting them focus on care where they provide the highest value-add. This is how we will make sure everyone can self-refer—not just the most confident and health-literate. Patients can access NIH-funded audiology services directly without having to wait for a referral from their GP. That means improved access to care and shorter waiting times.

My hon. Friend the Member for Uxbridge and South Ruislip and other hon. Friends stood, as I did, on a manifesto to halve health inequality between the richest and poorest areas of our country. I know he will agree that access should not be based on where we live. A key part of our elective reform plan, published at the start of the year, is transforming and expanding diagnostic services so we can reduce waiting times for tests and bring down overall waits. NHS England is working closely with services to improve access to self-referral options, aiming for a more consistent offer right across the country.

[Dr Luke Evans]

I am grateful that a comprehensive plan is coming forward. One problem we have is joining the leadership up. The Kingdon review, which was launched in May and finished in November, made 12 recommendations that will help align with all the missions the Minister is bringing forward. Can he tell us when the Kingdon review will be accepted and analysed by the Government, and their position on the recommendations, because it is a key thread to delivering all the ambition that he has rightly put forward?

[Stephen Kinnock]

I can—we are absolutely committed to responding to the Kingdon review next year. We are working on pulling together our response to the report. It is extremely important, and there are serious lessons to be learned from it. We think Dr Kingdon has done an excellent piece of work, and we are very keen to build on it and take it forward.

Community diagnostics, such as local hearing assessment clinics and testing in community settings, are being rolled out more widely through the expansion of our community diagnostic centres. We are opening more of these centres—12 hours a day, seven days a week, offering more same-day tests, consultations and a wider range of diagnostics. I am very proud that we now have 170 CDCs across England.

Almost 2 million audiology assessments have been carried out by NHS staff since this Government took office, including 136,000 tests in October—the highest number of audiology tests for a single month in the history of the NHS. This is a crucial step in supporting the NHS to meet its constitutional standards and deliver quicker care to patients. I also want to salute the work of the Welsh Government, who have been pioneers in many respects with their plan, published this week, showing how Wales is also leading in audiology services on care in the community, training and infrastructure.

The hon. Member for Hinckley and Bosworth asked about the Kingdon report, and in this debate on audiology services, I must take this opportunity to thank Dr Camilla Kingdon for the excellent review that she chaired into failures in children’s hearing services. As I have just told him, the Government are committed to responding to the recommendations made by Dr Kingdon, and we will publish a comprehensive response next year.

Community audiology services face challenges, with long waits and inconsistency in access to services, but we are taking action through the medium-term planning framework, by expanding community diagnostic centres and as an integral part of our 10-year plan. My hon. Friend the Member for Uxbridge and South Ruislip and I come from a political tradition based on solidarity, and this Government stand for a health service that leaves no person behind. I know that he shares my determination to get timely access to community audiology services for all 12 million of our compatriots who need them.

I thank my hon. Friend once again for bringing forward this extremely important debate, and I thank all Members who have spoken. It only remains for me to wish you, Mr Vickers, as well as your entire team and everyone else in the Chamber, all the very best for Christmas and the new year.

16:12

[Danny Beales]

We certainly heard about some issues today that I did not expect to be on the agenda. The waxiness or not of dogs’ ears will certainly stay with me for a while. I am glad that the hon. Member for Winchester (Dr Chambers) clarified that he is a vet. I wondered whether checking dogs’ ears was a particularly Lib Dem thing to do to, so I am glad he clarified that he does it professionally rather than personally.

We have had contributions from experts across the health sector and experts by experience of hearing loss, and I think we covered many of the key issues for audiology, such as workforce challenges and occupational hearing loss, as well as rural areas, regional variation and unacceptable delays. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) made a powerful point about the importance of quality assurance of services. Yes, we want more community access, but it needs to be quality community access.

I thank the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and the Minister for their kind remarks. I thank the Minister for visiting what he called the fantastic development of neighbourhood health services in Hillingdon. We are fortunate in that, as well as the developing neighbourhood hubs, we have an ICB community-based audiology service. Hillingdon is very fortunate in having community audiology services, and I hope such services will be provided in all ICB areas.

I welcome the Minister’s recognition of the importance of self-referral and the Government’s continued commitment to it. I also welcome his recognition of the need to deal with the issue of variation across the country. In his response, he mentioned the key opportunities in developing the workforce plan, which we expect in the spring, and this Government’s broader neighbourhood health agenda, and I hope that audiology will feature strongly in those developments.

Thank you, Mr Vickers, for your time and the Clerk for their time. I wish everyone a merry Christmas and a happy new year.

Question put and agreed to.

Resolved,

That this House has considered community audiology.

16:15

Sitting adjourned.