Hearing Loss in Adulthood

Lilian Greenwood Excerpts

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.

--- Later in debate ---

[Norman Lamb]

My responsibilities stretch only to England, but clear co-ordination and joint working with the devolved Administrations absolutely make sense on an issue that transcends borders, so I agree with the ambition that the hon. Gentleman sets.

This cannot just be about prevention because that is not always possible; it is also about dealing with the consequences of hearing loss. The Government are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We are developing measures to identify those with hearing loss as early as possible, including the roll-out of a national hearing screening programme for newborn babies that enables the early identification of deafness, providing a clear care pathway for services and allowing parents to make informed choices on communication needs.

Today, however, we are focusing on adults with hearing loss. I realise that there is currently considerable interest on hearing loss screening for adults, which the hon. Lady mentioned. The UK National Screening Committee advises Ministers and the NHS in all four countries on all aspects of screening policy. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria. In 2009, the committee recommended that routine screening for adults’ hearing loss should not be offered because of a lack of evidence to warrant such a screening programme. However, as part of its three-year review policy cycle, the committee is reviewing the evidence for a national adult hearing screening programme. A public consultation will be held shortly and details will be available on the committee’s website. I encourage the Ear Foundation and many others to contribute to that consultation.

We welcome the recent report by the Ear Foundation, which clearly sets out the benefits of cochlear implants for children and adults. Abigail’s story, as told by the hon. Lady, demonstrates what a massive impact that can have on an individual’s life. It completely transformed her life, and no doubt that experience is repeated very many times around the country. The report will be of enormous use to NICE if it decides to update the technology appraisal that it published in 2009. I encourage the Ear Foundation to engage with NICE. I am sure that it is already in touch, but it is very important for it to provide any emerging evidence to NICE to help it to update, if necessary, the guidance provided on implants.

A large number of services are already commissioned for people with hearing loss, and a number of specialist centres in England provide implants for children and adults. It is important that GPs understand the criteria for referral, as well as the obvious benefits of this technology for people with hearing loss. That touches on the hon. Lady’s point about the importance of health professionals, whether GPs or anyone else in the health system, gaining a better understanding of the potential for this technology. There have been considerable improvements to services for people with hearing loss in recent years, including reduced waits for assessment and treatment to within 18 weeks—a significant advance.

[Lilian Greenwood]

I thank the Minister for his positive response to the questions that I posed. What will he personally do to ensure that such training and updating on hearing technologies by health professionals and GPs takes place?

[Norman Lamb]

I do not want to give a bland answer, but I take this issue very seriously. I have noted what the hon. Lady has said. Health Education England is responsible for the training of health professionals. I will pursue the hon. Lady’s point and would be very happy to report back to her.

There is now a greater choice of hearing aid services through independent high street providers—which are easily accessible for members of the public—and the new any-qualified-provider commissioning model offers even greater choice and convenience.

We have also asked NICE to produce clinical guidelines and related quality standards for the assessment and management of adult-onset hearing loss and guidelines for the assessment and management of tinnitus, which the hon. Member for Strangford (Jim Shannon) has referred to in the context of Northern Ireland. Those guidelines will be scheduled into NICE’s development programme over the coming months.

Enabling those with hearing loss to have the same opportunities and to live as independently as everyone else is essential. It is therefore vital that public services are geared up to help and support them. Public authorities, including health and social care bodies, are required by the Equality Act 2010 to make reasonable adjustments for disabled people, to ensure that they can use a service as close as is reasonably possible to the standard usually offered to everyone else. The Department of Health has agreed to explore with its partners what more can be done to accommodate the communication needs of disabled service users.

Work is going on across the Government to support the needs of people with hearing loss. The Department for Transport’s Access for All programme has delivered access improvements at 1,100 stations since 2006, including induction loops at ticket offices and help points on platforms. The hon. Member for Nottingham South mentioned the specific problems that people face when travelling and the anxiety caused by worrying about not hearing an announcement. There will be facilities on platforms for deaf users and systems that show train information on LED display screens. Last year, a further £100 million was announced to extend the programme until 2019.

Courthouses have been provided with hearing loops since December 2012. In policing, police link officers for deaf or hard-of-hearing people use and are qualified in British sign language and work with the community to raise awareness of how to access the police. Staff in Derbyshire have passed level 1 of their training with Action on Hearing Loss, and they accepted an Action on Hearing Loss charter mark, “Louder than Words”, recognising the efforts they have made to communicate more effectively with deaf people. I pay tribute to those parts of the public sector that have made the effort to improve the way in which they communicate. Far more needs to be done, but they are the exemplars that others should follow. For those who do not use BSL, text relay, which enables deaf and hard-of-hearing people to text the police, is in place in most emergency call centres.

I hope that those examples give a flavour of some of the work that is being done across the public sector and confirm the Government’s continued commitment not only to preventing, but to treating hearing loss and promoting and protecting those affected.

[Lilian Greenwood]

Will the Minister give way?

[Norman Lamb]

The hon. Lady is just in time.

[Lilian Greenwood]

Before the Minister concludes his speech, will he address my specific suggestion to establish a lead commissioner for audiology, to ensure that there is a focus on good commissioning across the health service?

[Norman Lamb]

I will discuss that suggestion with NHS England, because that is its responsibility under the new design of the health system.

Let me end by congratulating the hon. Lady again on raising this really important issue, and I repeat that I am happy to engage with her to try to make progress.

Question put and agreed to.