Hearing Loss: Action Plan and Commissioning Framework

Jim Fitzpatrick Excerpts

Thursday 30th June 2016 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I beg to move,

That this House has considered NHS England’s Action Plan on Hearing Loss and the adult hearing service commissioning framework.

I am grateful for the opportunity to open this debate, and I am pleased to see you presiding over our business, Ms Vaz. I am also pleased to see the Minister and the new shadow Secretary of State for Health, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), in their places. I look forward to their comments.

I am disappointed that there are not more colleagues here, but given events taking place outside, it is perhaps no surprise that their focus is elsewhere. I am, however, particularly pleased that my hon. Friend the Member for Nottingham South (Lilian Greenwood), who chaired the all-party group on deafness before me, is here. She brought great enthusiasm and direction to that role and formed the work programme that the group is still following. I am also grateful to the Backbench Business Committee for granting me the opportunity to have a debate on this important issue, and to Alex Adcock and Tom Powell of the House of Commons Library, the UK Council on Deafness, the Royal College of Physicians and others for their briefings, which have helped me to formulate my comments.

I would like to put on the record how much work is being done. I do not intend to attack or criticise the Government; this debate is an opportunity to seek clarification on some of the important issues concerning deafness and hearing loss. The British Society of Audiology, the British Academy of Audiology and others have commented positively on the joint working on the action plan on deafness and the collective efforts to develop an overarching commissioning framework for hearing. That framework document is due to be published on 19 July and will be launched here in the Commons. Today was the closest date for securing a debate to give the Minister a platform to confirm the progress that has been made and to elaborate on arrangements for the day. But I am getting ahead of myself.

I am grateful for the opportunity to raise some issues for the Front Benchers to comment on. As I said, I am chairman of the all-party group on deafness, following my hon. Friend the Member for Nottingham South. We have an active all-party group, which is well supported by colleagues from both Houses of Parliament. I want to put on the record my appreciation for Dan Sumners of Signature UK, who was seconded to act as the admin secretary to the all-party group. I commend him for his support; he has done sterling work in service of the group. We are very grateful for that and wish him well in the future.

On a personal note, I wear two hearing aids. My hearing loss was originally diagnosed as industrially induced from my time in the London Fire Brigade, but I am sure that age could be contributing to my present difficulties. I thank the audiology department of the Royal London Hospital for the support and treatment that it gives me when I need assistance. I also thank the engineers and technicians who maintain the loop system here in the Palace of Westminster, which is very good in this Chamber, as it is in most of the venues in the House. In the main Chamber, it can be a little bit unpredictable, but there are speakers in the Benches to help with any difficulties we might have, so we are well served in these buildings.

Hearing loss affects more than 10 million adults and 45,000 children in the UK, which equates to one in six of the population, and it is estimated that by 2031, 14.5 million people in the UK—approximately one in five of the population—will have hearing loss. The most common form of hearing loss is age-related, and the prevalence of deafness approximately doubles with every decade of life.

The Royal College of Physicians says that NHS England’s action plan on hearing loss

“recognises significant regional variances of early diagnosis and care for children and adults with hearing loss. The document sets out a commitment to design and deliver excellent, high quality care audiology services to meet patient need. The National Improving Quality In Physiological Services accreditation programme (IQIPS)—run by the Royal College of Physicians…assesses audiology services across England to ensure they operate safely and to a high standard. IQIPS is a recognised marker of excellence in patient care and in reducing variances in audiology services.”

I recently visited Auditory Verbal in south London and attended its event held here in the Palace of Westminster. It demonstrated that the earliest diagnosis and treatment can help children who are born deaf or suffer severe hearing loss to learn to communicate normally, by using the brief window of the very early years to stimulate the auditory part of the brain before it loses the opportunity to develop. I commend Auditory Verbal for the work that it does. If the Minister is not familiar with that organisation and has not had the chance to visit it, I strongly recommend that he does so, because it is an inspiring experience. There are a lot of great people around the country working with and for that organisation.

Officers of the all-party group were grateful to the Minister for the opportunity to meet him recently to discuss the action plan and to ask about the commissioning framework. This debate is a continuation of that dialogue. We raised a number of issues, such as the provision of hearing aids; a national screening programme; promoting the prevention of hearing loss; providing innovative models of care; active support for people with hearing loss; and the recognition of British sign language.

The action plan addresses those issues and sets out five key objectives: good prevention to reduce the numbers of young people and adults with noise-induced hearing loss; earlier diagnosis to improve outcomes for babies with hearing loss and increase identification of children and adults in at-risk groups; integrated services; increased independence and ageing well; and good learning outcomes, including improving employment opportunities for young people and adults and reducing development and attainment gaps between deaf and hearing children.

The briefing from the UK Council on Deafness was very helpful in outlining the background to today’s debate. It says:

“This debate has been called prior to the publication of the NHS England adult hearing service commissioning framework. The framework will be launched in Parliament at 2pm on 19 July in the Boothroyd Room”.

I hope that a lot of colleagues will be able to turn up to support that event. It continues:

“The framework is an outcome of the NHS England Action Plan On Hearing Loss, published on 23 March 2015.”

All-party group officers told the Minister at our meeting that we commend the officials within the Department of Health and NHS England for their sterling work in drafting the report and bringing together the commissioning framework. There are a lot of great people doing great work. I have met and listened to a number of them in different meetings, and we are very grateful for all their efforts in this area of policy.

The UK Council on Deafness says:

“The aim of the action plan is to do more on prevention, early diagnosis and support for those who have permanent hearing loss.”

It makes the important point that the action plan acknowledges that

“without hearing aids people are ‘at greater risk of social isolation, and reduced mental well-being…there is a strong correlation between hearing loss and cognitive decline, mental illness and dementia’. The Ear Foundation has estimated the cost of untreated hearing loss to be £30 billion per year. It has found that hearing loss is associated with reduced income of £2,000 per year on average. Wearing hearing aids halves that loss. At least £25bn in potential economic output is lost each year because of a lack of support for people with hearing loss and deafness.”

The council also quotes Action on Hearing Loss, which

“has found that people wait on average 10 years to seek help after they first notice symptoms of hearing loss. Only a third of people who need hearing aids have them, leaving 4 million people with unmet needs. Yet hearing aids are shown to improve quality of life, and 90 per cent of people continue to use and benefit from hearing aids.”

The UK Council on Deafness also raises the issue of cuts in the provision of hearing aids, pointing out that some clinical commissioning groups proposed limiting access to hearing aids in 2015-16. Following a campaign, most decided to halt those proposals as the commissioning framework was being developed. However, North Staffordshire is reported to have implemented the cuts, and the risk of further rationing remains. Perhaps the Minister will comment on that.

The council also comments that in January, the national screening committee decided not to recommend an adult hearing screening programme. The all-party group has also made that point to the Minister. We fell that without an assessment of the scope and size of the problem, and of the quality of the response from NHS trusts across England, a question mark was left over whether hearing loss was being adequately assessed and the quality of provision adequately outlined.

On the recognition of British sign language, the UK Council on Deafness says that deafness has been put firmly on the agenda by the British Sign Language (Scotland) Act 2015 and the announcement by the Northern Ireland Executive that it plans to bring forward legislation relating to British and Irish sign languages. Perhaps the Minister will comment on BSL. There is a campaign for recognition in England, as there has been in Scotland and Northern Ireland.

As chair of the all-party group, I should put on the record my thanks—I am sure I echo the thoughts of my hon. Friend the Member for Nottingham South from when she was chair—to colleagues from both Houses who support the group so positively. The Minister knows from the parliamentary questions that come across his desk and from occasional debates and early-day motions that deafness is a matter of interest in the Commons. However, the number of parliamentary actions that my colleagues and I initiate do not reflect the importance of the matter or the number of people affected in this country. I hope that our efforts today and the positive progress that the Government and NHS England are making will reassure the people affected, and those campaigning with them and on their behalf, that the Government and NHS England recognise the condition of hearing loss and that it is being addressed.

As I started by saying, the all-party group requested this debate to demonstrate how much NHS England has done, to raise matters of ongoing interest or concern and to see what more we could solicit from the Minister on the issues that he knows are live within NHS England and the Department. I know he is very much on top of his brief, and I look forward to his comments. We look forward to 19 July and the publication and launch of the framework document, so that the provision for people suffering hearing loss can be not only understood but maintained and improved.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to speak under your chairmanship, Ms Vaz. Thank you for chairing this important debate.

Whatever else may be going on in this place at the moment, it is important that every now and again we return to what most people would regard as real life. As both Government and Opposition Members, we should give a strong sense of how we remain very engaged with matters that affect people every day. We will continue to do so.

I am grateful to my friend, the hon. Member for Poplar and Limehouse (Jim Fitzpatrick), for bringing the subject before the House. It is some time since we played football together—too long—and we will have to find another way to do that. I have great fondness for the hon. Gentleman, who represents his constituents well, and who has always raised this cause in the best possible way, being informative as well as challenging when in opposition. I appreciate his work, and the work of the hon. Member for Nottingham South (Lilian Greenwood), in particular with the all-party group, which is so essential to keep Members informed about what is going on and what we need to be engaged with. I endorse the thanks to those who promote and support the all-party group and its work.

I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her role as the shadow Health Secretary. I thank her for her contribution today, and I look forward to hearing more from her. I appreciate the many burdens on her and her colleagues, so I appreciate her taking part in the debate.

The hon. Member for Poplar and Limehouse set out, broadly, the situation affecting the action plan and looked forward to the next stage, including the commissioning framework, which I will touch on. He spoke about the practicalities of life, paying tribute to those who put in the loop systems, and about how well technology has improved over the years—a sentiment I share. He made reference to a couple of specific topics that I will cover.

The hon. Member for Nottingham South did the same and spoke about the effects of deafness. Some years ago, as colleagues might be aware, I was Minister with responsibility for people with disabilities, and when she spoke about the importance of communication, I remember in particular a visit I made to Sense, the deaf-blind charity, at its premises in Peterborough, where I was introduced to a number of people. The importance and value of communication were brought home to me when I engaged with one particular gentleman, who understood what people were saying because he put his finger on their lips to follow the conversation. He could not see or hear, but his finger on their lips meant that he could follow the shape of the mouth. He then tapped out his reply on the back of his carer’s hand. Think how easily we communicate, at the drop of a hat, and see what someone was prepared to do because he was desperate to communicate. That reminds us of the absolute value of communication to human life and existence. I remember that example to this day, even 20 years on.

When the hon. Lady and other colleagues were talking about what being deaf means, how it affects life, how hearing and communication are a vital part of people’s existence, and about the absence of those and the difficulty that it brings, they brought home to me just how important the subject is. That is why I value the debate, and I am grateful to the Backbench Business Committee for allowing it and to the hon. Member for Poplar and Limehouse for securing it.

The shadow Secretary of State for Health also raised matters of rationing, financing and screening, so I will now cover those with my prepared remarks.

I congratulate the hon. Gentleman on securing the debate on NHS England’s action plan on hearing loss and the adult hearing service commissioning framework. The advent of the commissioning framework on 19 July will mark an important milestone. I share his sense that it is an important event. We hope that many people will come to the launch. It is only right, therefore, that we come together to discuss the opportunities and challenges that the publication presents.

As colleagues have mentioned, hearing loss is widespread. More than 10 million people in the UK are affected, and our rapidly ageing population means that that number is set to grow. As mentioned, projections show that by 2031 there will be more than 14.5 million people with hearing loss in the UK. Those demographics alone provide compelling evidence for why the UK needs to step up its response to hearing loss to enable further research, to take action on prevention and to enable people with hearing loss to access the services and support they need.

The Department of Health and NHS England’s action plan on hearing loss, published in March 2015, recognises the impact of deafness and hearing loss on individuals and society as a whole. Crucially, in my view, the plan accepts that hearing loss is not only a health issue, as we have been saying, but a cultural one. Tackling that societal challenge requires an integrated approach across the public, private and third sectors.

NHS England is therefore committed to delivering 20 outcome measures across five key areas, which have been touched on: prevention; early diagnosis; patient-centred, integrated management; ensuring that those diagnosed do not need unscheduled care or become isolated; and enabling inclusion and participation. That work will be spearheaded by a range of multidisciplinary groups with cross-sector representation.

The publication of the plan heralded an important new chapter in driving essential improvements, but we know that there are significant challenges for hearing services. Adults with hearing loss wait, on average, 10 years before they seek help—again, as colleagues have said—and, when they do visit their GP, 30% to 45% are not referred on for a hearing assessment. We know about significant unmet need and variation in services. For example, only about two fifths of people who need hearing aids have them. I have also heard some disquieting anecdotal accounts that some clinical commissioning groups have been taking difficult decisions and considering the rationing of hearing loss services.

Some of the news is helpful, such as the statistics on when referrals are made and things move forward. In 2013-14, 84% of people seen were seen within 16 days of referral; 92% were fitted with hearing aids within 20 days; 97% had their first follow-up within 70 days; and 800 different types of hearing aid were available from the NHS supply chain. So once someone is in the system, things are available, but we want to improve the provision of services.

[Jim Fitzpatrick]

Will the Minister give way?

[Alistair Burt]

I was about to come on to rationing, but I am happy to give way at this stage.

[Jim Fitzpatrick]

My hon. Friend the Member for Nottingham South (Lilian Greenwood) mentioned—I think this was in my notes, and the Minister just repeated it—the numbers who are not referred on by GPs. I have not got to the bottom of why that is. GPs are not auditory specialists, so we would think that if someone comes to them and presents with audiological problems, the logical thing would be to send them to their local trust, who are the experts and have sound-proof booths, technicians and specialists, to identify and assess the nature of the problem. I have read that figure a couple of times. but I have not got to the bottom of why they are not being referred. I am not sure whether the Minister will have an answer, but I thought I would raise that point.

[Alistair Burt]

I must confess that I do not have an answer. He makes a perfectly fair point. Whether or not that is what people raise at the time they are in the surgery or whether they recognise it themselves or minimise it by saying, “I’m just getting old” or whatever, I do not know. I will make an inquiry and see what research we have at present. Family practitioner care and GP services are under constant review, and we have a number of different pilots and vanguards looking at the provision of primary care services.

I will see what emphasis is being given to this particular aspect. Certainly we recognise that the demographics indicate that all issues associated with getting older, which can include hearing loss, are rising up the scale and the agenda. I will make specific inquiry about whatever reasons we have at present in relation to this matter and write to each of the hon. Members present to give that information. I am very happy to do that.

--- Later in debate ---

[Jim Fitzpatrick]

Thank you for the opportunity to make a couple of closing comments, Ms Vaz. I am grateful to the shadow Health Secretary, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), for being here today and for her contribution. I especially thank my hon. Friend the Member for Nottingham South (Lilian Greenwood) for her contribution. She demonstrated her complete awareness of these matters and her long-standing commitment to campaigning on them in her constituency and here in Parliament, as a former leader of the all-party group on deafness.

I thank the Minister not only for his response and the reassurances he gave but for the obvious personal commitment he brings to the role he now commands. He is held in high regard by many of us. We look forward to working with him, supporting him and encouraging him in his continued endeavours in this area. I am grateful for the opportunity to have this debate.

Question put and agreed to.

Resolved,

That this House has considered NHS England’s Action Plan on Hearing Loss and the adult hearing service commissioning framework.