Hearing Loss in Adulthood

Debate between Jim Shannon and Lilian Greenwood

Tuesday 12th November 2013 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

I am glad that we are debating an issue that affects all our constituencies, and I know that it is a matter of real concern to many Members in this House and in the other place.

I would like to begin by paying tribute to the work of the Ear Foundation, a cochlear implant support charity in my constituency. I was glad to secure the debate, and I hope that it will draw attention to the vital work it does to support adults and children with hearing loss.

One in six people in the UK experience hearing loss, and seven in 10 can expect to be affected by the time they reach their 70th birthday. That means that 10 million people live with hearing loss, and an ageing population means that that number will rise in the years ahead. To communicate is to be part of society. Losing one’s hearing is not just about the absence of sound—if not addressed, hearing loss can result in the loss of our social life, cutting us off from family, friends and work.

Deafness in adulthood is linked to depression, unemployment, poor mental and physical health and an increased risk of other conditions, including dementia. Hearing loss is a constant condition, and in most cases there is no cure. It is no exaggeration to say that it can destroy lives. People with hearing loss can find it difficult to negotiate everyday challenges in the workplace, on the bus, at the supermarket, or in the local doctor’s surgery, leading to isolation, exclusion and frustration.

Research carried out by Action on Hearing Loss has found that adults who lose their hearing are likely to withdraw from social activities. When they do take part, communication difficulties can result in feelings of loneliness. Hearing loss can also damage personal relationships. Many deaf people find it difficult to join in with family conversations and jokes. Couples say that they feel more distant from their friends, and partners of people with a hearing problem describe feelings of loneliness and frustration. Travelling on public transport becomes a challenge, and a platform alteration or a delayed connection can be a major problem if someone misses the announcement. That can leave deaf people feeling anxious and vulnerable when travelling, and worried about being stranded or lost. The debate among policy makers focuses mainly on quality-of-life issues, but failure to address hearing problems has implications for society as a whole.

[Jim Shannon (Strangford) (DUP)]

I have sought the hon. Lady’s permission to intervene in the debate. In Northern Ireland, 300,000 adults experience deafness or tinnitus—a sixth of the population, which is similar to the rest of the United Kingdom. Does she agree that a UK-wide strategy—and perhaps the Minister would respond to this—would benefit the core of the community across the United Kingdom, especially people with deafness?

[Lilian Greenwood]

I thank the hon. Gentleman for his intervention. He is quite right: these are issues that affect the whole of society, and I hope that the Minister will respond positively to his suggestion.

A 2006 study estimated that unemployment resulting from hearing loss cost the UK economy £13 billion a year. Too many people are forced to resign, retire or face redundancy as a result of their disability. People with hearing impairment report that their employers often have a passive attitude, providing adjustments and support only when prompted, and a significant number face outright discrimination.

Of the 300,000 people of working age with severe hearing impairment, 20% report that they are unemployed and are seeking work. Another 10% report that they cannot seek work as a result of their condition. As the state pension age rises and more jobs depend on communication skills than was the case 20 or 30 years ago, that vulnerability to unemployment is a growing problem. It represents a worrying underuse of the economic capacity of the nation.

Despite the scale and impact of hearing loss in the UK, adults with profound and severe hearing problems face major challenges when accessing health services. For many people, even seeing their GP can be a challenge, especially when surgeries rely on telephone booking systems and do not use visual display screens. One in seven respondents to an Action on Hearing Loss survey reported missing the call for their appointment while sitting in the waiting room. Poor deaf awareness among health professionals, such as not looking directly at a patient to allow for lip-reading, can lead to patients with hearing loss feeling unclear about the medical advice or information provided. According to the same survey, 28% of people with hearing loss have been unclear about a medical diagnosis and 19% have been unclear about their medication.

Diagnosis of hearing loss among adults is too often down to chance. Many are reluctant to seek help, and evidence suggests that people wait an average of 10 years before doing so. Stigma is a key factor in this delay in taking up hearing aids, which makes some people unwilling to tell others about their hearing loss. An Action on Hearing Loss report found that one element of stigma is the fear that deaf people are seen as less capable. A 2005 MORI poll of more than 20,000 people showed that one in five expressed concern about being treated differently.

Earlier diagnosis is essential to ensuring that people with hearing loss can access the support and services that can help them best manage their condition. A hearing screening programme for people aged 65 would help to overcome some of the barriers that prevent people from addressing their hearing loss. I pay tribute to the hon. Member for Eastbourne (Stephen Lloyd), who has led the Hearing Screening for Life campaign. Research by the consultancy London Economics suggests that such a programme would represent good value for money, so will the Minister consider establishing a pilot hearing screening programme?

There are approximately 4 million people with undiagnosed hearing loss in the UK who could benefit from hearing aids or, in a smaller number of cases, a cochlear implant. However, research suggests that GPs are often reluctant to refer patients for assessment or lack the knowledge to do so. Forty-five per cent. of patients presenting hearing loss symptoms are not referred, so something is clearly amiss. GPs’ lack of awareness of the impacts of deafness in general and a lack of knowledge of the benefits of cochlear implantation in particular give rise to concern. Greater education of GPs and audiologists on hearing technologies and the potential benefits of cochlear implantation for adult patients is therefore vital. I would be grateful if the Minister updated the House on the Government’s plans to ensure that training and updating on hearing technologies is provided consistently across the country.

Despite the obvious need, there is relatively little recognition of the impact of hearing loss or of the latest technologies that can improve hearing. We know that hearing aids improve adults’ health-related quality of life by reducing the psychological, social and emotional effects of hearing loss. For those who are severely or profoundly deaf, and for whom hearing aids offer little benefit, cochlear implants offer the chance of useful hearing.

[Jim Shannon]

I thank the hon. Lady for giving way; she is being very gracious. One of the issues that have come to my attention as an elected representative is that hearing aids are sometimes thought of as a big thing attached to the ear, but thanks to the advance of technology hearing aids are very small now. Perhaps that means that cosmetically they are less noticeable, and people can have the implant and lead a normal life. Is that one of the things that the hon. Lady feels should happen?

[Lilian Greenwood]

My hon. Friend is right. There is a need to increase awareness of what a cochlear implant is, how it operates and even what it looks like.

Despite the digital revolution in the NHS, in which high-quality hearing aids are now routinely fitted, there remains an under-utilisation of implants for adults, notwithstanding comparable advances in implant technology. One person who has benefited is Abigail from Nottingham, who found her implant an enormous benefit to her life. She was born deaf and grew up wearing two hearing aids until her hearing deteriorated, and doctors told her that hearing aids were no longer of benefit to her. Following detailed and intensive assessment she was approved for an implant, and when this was switched on it gave her new-found confidence. It rebuilt her self-esteem, enabling her to communicate more comfortably with her husband, family, friends and colleagues. Having a cochlear implant has given her a new lease of life, without having to rely on others to help her with communication, such as by telephone. It has also helped her immensely at work, where she can now communicate with colleagues on an easier level. It has helped her gain promotion and do a job that she enjoys. The cochlear implant has enabled her to get on with life at home, at work and socially, and with her hobbies, including music. She also does volunteering work in the community.

A cochlear implant stimulates the hearing nerve by means of rapid electrical impulses, which bypass the non-functional inner ear in people who are severely or profoundly deaf. Sounds heard with a cochlear implant are not the same as those heard with a human ear, but with the right support a person with a cochlear implant can adapt to the novel signal and use their implant to understand speech and other sounds, much like normal listening. One cochlear implant recipient said:

“I feel that so much of my previous life and true self has been restored, regaining my pride and ability to contribute actively in society on an equal basis.”

The late Lord Ashley, who is remembered and was rightly held in extremely high regard by many in this place, was known to call his cochlear implant a miracle. Surely it is time that everyone who needs a cochlear implant had access to their own miracle. There are an estimated 100,000 people with profound hearing loss, and 360,000 with severe loss. Although it is difficult to determine the exact number of adults who need an implant, on any of the current measures of profound deafness the current level of provision for cochlear implantation would appear to be significantly below any predictions of need.

The Ear Foundation suggests that as few as 5% of adults who might be able to benefit from an implant are currently getting one, and the UK is fitting only half the number of implants in adults as Germany and Austria. Speaking at last month’s Westminster launch of the Ear Foundation report “Adult Cochlear Implantation”, Dr Andrew Dunlop, a GP who suffered sudden hearing loss himself, described his own experience of deafness, undergoing assessment and receiving a cochlear implant. He said:

“I was fortunate, that as a healthcare professional, I knew my way around the system and was not overwhelmed when dealing with fellow doctors, audiologists and consultants. Sadly, the story for less informed individuals is not quite the same. My return to Practice emphasized to me just how much of an iceberg of unmet need is within the community at large, with many very able individuals assuming wrongly that they have no options after optimal provision of hearing aids and seem reduced to a second class life of social isolation, loss of self-esteem and frequently unemployment.”

Today’s debate is my attempt to chip away at that iceberg.

The criteria for implants are set by the National Institute for Health and Care Excellence, with guidance last reviewed in 2011. However, the criteria are based on evidence from patients who were predominantly wearing technology from the late 1990s, and since then there have been significant advances in cochlear implant technology. Many clinicians would argue that the criteria do not reflect real world listening, and that more realistic tests should be deployed instead.

Since the last review, there have been supportive studies on the effectiveness of bilateral implants—one implant for each ear—which NICE believes provide too little benefit for adults to justify NHS funding. One patient who was refused implantation described the process as follows:

“The conditions they did the testing in were ideal. It was perfect but they made no allowance for the difficulties you get if somebody is talking from the side, or if there is any background noise…and of course under those circumstances you do very well and it makes no allowances for the problems you run into in real life.”

In addition, the use of sentence tests, rather than monosyllabic words, enables deafened adults to use their previous linguistic knowledge to complete the test, thus appearing to have hearing that is too good for cochlear implantation. Brian Lam and Sue Archbold, authors of the Ear Foundation report, conclude that there is an urgent need to look at the deployment of a wider range of tests. They also argue that testing in noise and assessment of performance with monosyllabic words would be more appropriate. This would reflect current practice in Germany, where criteria are more flexible.

A growing body of evidence indicates that bilateral implants provide added improvements in speech perception in noisy environments over unilateral implantation, and better sound localisation, leading to improved quality of life. The Ear Foundation has recommended that NICE review its current guidance on cochlear implantation, and in particular on the criteria for unilateral and bilateral implants for adults. Will the Minister look into this matter and consider asking NICE to conduct such a review? Does he agree that where a clinician believes that it is in the best interests of an individual patient, there should be some discretion in applying these guidelines?

Charities in the field have welcomed the Department of Health’s development of a national hearing loss action plan, but they are disappointed that it has been delayed by a year. I join those charities in urging the Government to prioritise its publication. Last month the noble Baroness Jolly stated in the other place that the Government aim to publish the action plan as soon as possible. I would be grateful if the Minister updated the House on when it will be published and how its implementation will be monitored. Has he assessed the suggestion of establishing a lead commissioner for audiology so that there is greater focus on good commissioning across all clinical commissioning groups?

The right hon. Member for Gordon (Sir Malcolm Bruce), who chairs the all-party group on deafness, last month challenged the Government, and any Government who come after them, no longer to leave deaf people behind. Today I echo those words. I hope that the Government can help move this issue, which affects all our constituencies, beyond debate and ensure that action is taken to address it.

Under-occupancy Penalty (Nottingham)

Debate between Jim Shannon and Lilian Greenwood

Monday 18th March 2013 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

“Nowhere to go”—that is how today’s Nottingham Post describes the crisis facing thousands of social tenants in our city. Why? Because two weeks today the Government are set to play the cruellest joke on more than 6,000 of our city’s poorest households. On the same day as they deliver a huge tax cut to the UK’s highest earners, they plan to take £4.23 million from the pockets of those people in our city who are least able to afford it. Whether we call it the bedroom tax, the under-occupancy penalty or the spare-room subsidy, it is a heartless policy that, the Cambridge Centre for Housing and Planning Research concluded, will create “severe hardship” for affected households.

Let us look at the households affected. Two thirds of them include someone who is disabled, one third are families with children, more than a fifth are working households on low wages, and many of them do not have a spare room at all. They include families whose children have their own rooms. Let us face it, some bedrooms are so small that they are barely big enough for one child, let alone two. Many families do not think it is fair to expect their teenage son or daughter to share with a toddler, even if they are the same sex, and children’s education can suffer if they do not have somewhere quiet to study.

So-called spare bedrooms are also needed where couples sleep separately, especially where a husband or wife cares for their disabled partner and desperately needs a decent night’s sleep. Some are used to store disability-related equipment. Where parents are separated, these bedrooms are needed for when their children visit at weekends. Are the Government really saying that people who live in a council or housing association home cannot have a spare room for their children or grandchildren to sleep in when they come to visit? It seems so. People who have lived in the same house for decades and spent time and money making it their home all face the same impossible situation: move out or find the extra money.

For people in Nottingham, that means on average an extra £11 a week if they have one room more than they are allowed, or £22 a week if they have two rooms. That may not sound like very much to the Minister, but for someone on jobseeker’s allowance of £71 a week, it is the difference between eating or going hungry, turning on the heating or sitting in the cold, borrowing money to pay your rent or going into arrears. This morning on Radio Nottingham, a local Tory Member of Parliament did not know what the fuss was about. She had explained to her constituent that she should simply move house. But of course, it is not that easy.

[Jim Shannon (Strangford) (DUP)]

The bedroom tax and the under-occupancy terminology will affect people throughout the United Kingdom. In Northern Ireland, we will be £10 million shy in the money available, and 32,000 households will be affected. Is not one of the greatest discrepancies of the whole process that there are not the smaller occupancy houses to move to, so all these people will have to find the extra money?

Public Forest Estate (England)

Debate between Jim Shannon and Lilian Greenwood

Wednesday 2nd February 2011 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

I have been prompted to speak in today’s debate by the tremendous anxiety expressed by so many of my constituents about the Government’s proposals. I know that this is not a concern peculiar to residents in my city, but perhaps Nottingham folk feel it even more keenly because they regard themselves as the descendants of our great hero Robin Hood, who made his home in nearby Sherwood forest. I was going to say that Robin’s hiding place, the 1,000-year-old Major oak in Sherwood forest country park, is safe from the proposals, because it is in a national nature reserve managed by Nottinghamshire county council and because even the council’s aptly named leader, Kay Cutts, would not dare to take her axe to our famous forest. However, I read earlier today that the Government are shortly to begin a consultation on divesting themselves of the country’s national nature reserves too, so, perhaps like many of our Forestry Commission local woodlands, the Major oak’s future is not secure either.

Nottinghamshire has nine Forestry Commission woodlands, including the east midlands’ largest tract of forest open to the public, Sherwood Pines forest park, which is just a few miles north of Nottingham. Sherwood Pines is a large mixed conifer and broad-leaf woodland with open spaces, heathland and pond, providing space for timber production, wildlife and recreation. I have been a regular visitor to Sherwood Pines since my children were small, and in that time I have witnessed the tremendous work that the Forestry Commission has done to encourage local people to get out and enjoy our beautiful countryside. There is a new café and visitor’s centre, children’s play areas, walking and cycling trails, a mountain biking area, an adventure course with ropes and zip wires, and, away from the centre, miles of peaceful woodland habitat and wildlife to enjoy. The forest is also used by many local schools, and the education service at Sherwood Pines was one of the first to be awarded a Learning Outside the Classroom quality badge.

Sherwood Pines is well developed as a visitor attraction, so perhaps public access would be secure, but what of the local woods that so many people enjoy, such as Blidworth woods, Haywood oaks, Silverhill wood, Boundary wood, Thieves wood, Oxclose wood and the Birklands? The Government tell us not to worry. The Secretary of State says that public rights of way and access will be unaffected, but can we trust this Government? My constituent Dr Chris Edwards certainly does not, saying that he has

“no faith in the promises being made to preserve access…this is the government that’s broken every election promise it made”.

This is the Government who promised to keep the education maintenance allowance and told us that there would be no more top-down reorganisations of the NHS—a Government who include Ministers who signed pledges saying that they would scrap tuition fees, but then voted to treble them. I would say that their promises are not worth the paper they are written on.

The Countryside and Rights of Way Act 2000 guarantees public access on foot, but as I have explained, the Forestry Commission has done much more than that, providing car parking, signage, visitor centres and leisure opportunities. The Government proposals contain no safeguards to guarantee that they will continue in the future.

[Jim Shannon (Strangford) (DUP)]

Is there not something obscene about the sale of English woods and forests when the other regions of the United Kingdom—Scotland, Wales and Northern Ireland—have all decided to retain their forests, keeping rights of access and the right to roam for ever?

[Lilian Greenwood]

The hon. Gentleman is absolutely right: those are things that we should protect. We should seek to learn from countries that appreciate the value of those public assets. Indeed, recent experience tells us that we are right to be wary. Rigg wood near Coniston water was sold off last autumn.