Community Audiology

Edward Leigh Excerpts

Thursday 18th December 2025 Westminster Hall

[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.

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[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.

--- Later in debate ---

[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.