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In this Report
Commons Written Answers (5 Jan 2004)
Deaf People
Tim Loughton: To ask the Secretary of State for Health
(1) how many interpreters for deaf people are available in each hospital trust;
(2) how many interpreters for deaf people are employed by the NHS.
Mr. Hutton: The information requested is not collected centrally.
Tim Loughton: To ask the Secretary of State for Health what arrangements are in place to communicate with deaf mothers in labour in hospital maternity departments.
Dr. Ladyman: The Department is firmly committed to improving access to information services and levels of awareness of disability issues, in particular by supporting the national health service in meeting legislative requirements. We are working in partnership with the Disability Rights Commission to take forward a series of actions aimed at improving the experiences of disabled people in the health and social care system. A working group is being established to drive forward work on access and communications.
Commons Written Answers (5 Jan 2004)
Occupational Deafness
Mr. Mahmood: To ask the Secretary of State for Work and Pensions what plans he has to amend the criteria for entitlement to state benefit on the grounds of occupational deafness.
Mr. Browne: We have no current plans to amend the criteria for entitlement to Industrial Injuries Disablement Benefit for occupational deafness.
However, the Industrial Injuries Advisory Council completed a review of occupational deafness last year, all its recommendations have been accepted and amending legislation came into force on 22 September 2003.
Commons Written Answers (5 Jan 2004)
Audiology
Mr. Chope: To ask the Secretary of State for Health
(1) how many people are waiting for the fitting of hearing aids in each primary care trust, having already had an assessment; and what the average time between assessment and fitting has been in the last 12 months;
(2) what service standards he has set for NHS audiology services, with particular reference to the length of time for which patients for audiology services wait; and what action the Government is taking to improve performance against standards;
(3) if he will make it the policy of the Government that those who have been waiting for more than six months for an (a) audiology hearing assessment and (b) audiology assessment should be able to have such assessments (i) carried out privately and paid for by the NHS and (ii) carried out overseas at NHS expense;
(4) if he will list in respect of each primary care trust the number of people waiting for a hearing assessment, and the number waiting for more than six months.
Dr. Ladyman [holding answer 18 December 2003]: While there are no targets for waiting times for audiology services, we are taking action to tackle the causes of longer waits as part of our programme to modernise hearing aid services in England.
The modernisation project team at the Royal National Institute for Deaf People and the Action On team from the NHS Modernisation Agency are working with sites to help them reduce waiting times. In this financial year, we are investing £1.56 million in specific initiatives to increase the capacity of individual audiology departments. We are introducing a new, more streamlined patient process in modernised sites. We are looking at ways to increase the number of trained audiologists in the longer term and are encouraging partnerships between national health service trusts and High street registered hearing aid dispensers to increase capacity and make NHS hearing aids available, free of charge, from an increasing number of convenient locations.
Commons Hansard (5 Jan 2004)
British Sign Language
Mr. Jim Cunningham (Coventry, South) (Lab): What recent discussions her Department has had with the Department for Education and Skills on ways to increase the use of British sign language on television.
The Minister for the Arts (Estelle Morris): My Department is an active member of the British sign language working group, which was established by the Department for Work and Pensions.The Communications Act 2003 extends, for the first time, the signing target on digital terrestrial television to digital cable and satellite broadcasters. That target is that 5 per cent. of all non-excluded programmes should be translated into sign language.
Mr. Cunningham: I thank my right hon. Friend for that answer, but may I ask her, first, whether she has a time scale for expanding those sign language programmes; and secondly, whether she is prepared to provide incentives to encourage more of them?
Estelle Morris: There is indeed a time scale-that the target should be reached by the 10th anniversary of the start of the service. That differs depending on the broadcaster concerned. For the BBC it is 2008; for some of the others it is 2010. I am not about to announce any incentives to ensure that it is reached, but it will be closely monitored through Ofcom. My hon. Friend may want to know that towards the end of last month, Ofcom published its code for people with sensory impairment, in which it set out its plans for ensuring that the target was reached and how it intends to monitor and enforce it. I very much hope that we can make progress on this important issue.
Mr. Tim Boswell (Daventry) (Con): Of course, we welcome the recent official recognition of British sign language, as we do any practical action that is taken by Government or broadcasters to improve their services to people with disabilities; but given that although the broadcasting code has been extended, the figures in it have not been increased, can the Minister tell us when there will be any material sign of improvement in coverage of signing for hearing-impaired people? For that matter, when does she hope to resolve the related issue of the current technical and/or commercial impasse in extending audio description for blind service users?
Estelle Morris: The hon. Gentleman raises some interesting points. When I looked at the targets I was amazed that the target for sign language was much lower than those for other measures to help people with sensory impairment. One of the problems is that there is not a closed system, so that when programmes are signed everybody accesses the sign language as well as watching the full screen. It is hoped that in the near future, people who want signing will be able to turn it on, while those who do not want it will not need to have it. I suspect that when that technology is available there will be much faster progress towards the target. I do not set much store by the fact that the target was met, given that it was only 2 or 3 per cent.-it has now been increased by 5 per cent. More important is the ongoing technological work to create a closed system.
On the hon. Gentleman's second point, I am told that work is progress. We hope that there will soon be a workable mechanism to make access to television for people with sensory impairments more probable. From now on, progress should be much quicker.
Commons Written Answers (5 Jan 2004)
Tinnitus
Mr. Todd: To ask the Secretary of State for Health if he will list research projects on tinnitus funded by his Department in the last 10 years; and if he will make a statement.
Ms Rosie Winterton: Details of research projects on tinnitus funded by, or of interest to, the national health service are available on the national research register (NRR) at www.doh.gov.uk/research/nrr.htm. The NRR currently contains details of six on-going and 26 completed projects on tinnitus.
The Medical Research Council (MRC) funds research on hearing, some of which would be relevant to tinnitus. Figures for MRC spend on hearing research are available for the years shown in the table:
2001-02 £3.94 million
2000-01 £4.96 million
1999-2000 £3.34 million
1998-99 £3.49 million
1997-98 £3.23 million
The MRC always welcomes high quality applications from the scientific community for support for research into any aspect of human health, including tinnitus, and these are judged in open competition with other demands on funding.
Lords Written Answers (7 Jan 2004)
Digital Hearing Aids
Lord Ashley of Stoke asked Her Majesty's Government: Which factors influenced the change in cost of digital hearing aids from a selling price of £2,500 to £70 for the National Health Service.
Lord Warner: The price of £2,500 for a digital hearing aid was the price charged by private sector dispensers, and includes service costs for assessment, fitting and follow up appointments, general business overheads, marketing and profit margin.
The factors that influenced the reduction in cost of digital hearing aids to the National Health Service were: the development of a single procurement system that takes advantage of economies of scale of purchasing; the ability to give commitment for specific volumes of product to suppliers; the ability to forecast demand to suppliers; and the shifting of demand for high volume products to fewer suppliers. This was made possible through the partnership between the Department of Health and the Royal National Institute for Deaf People, who worked with the private sector as part of the Modernising Hearing Aid Services programme.
Commons Written Answers (12 Jan 2004)
Audiology
Mr. Chope: To ask the Secretary of State for Health
(1) what action the Government is taking to guarantee that everyone in Dorset who can benefit from a digital hearing aid provided on the NHS will have received one by April 2005;
(2) how many people in Dorset he estimates may benefit from digital hearing aids; and what proportion of these will have been fitted with digital hearing aids by 1 April (a) 2004 and (b) 2005.
Dr. Ladyman [holding answer 18 December 2003]: The question of whether someone can benefit from a digital hearing aid is one of clinical judgment. The Modernising Hearing Aid Services Project, in which the Government are investing £94 million for the two financial years 2003-04 and 2004-05, will ensure that all audiology departments in England will be fitting digital hearing aids routinely by April 2005.
Commons Written Answers (15 Jan 2004)
Deaf Children
Jon Trickett: To ask the Secretary of State for Education and Skills what steps his Department has taken to ensure access to the full school curriculum for all deaf children; and if he will make a statement.
Margaret Hodge: All maintained schools - mainstream and special - are required to provide the full national curriculum and to ensure that all deaf children have access to it, other than where it has been disapplied.
Commons Written Answers (15 Jan 2004)
Audiology
Tim Loughton: To ask the Secretary of State for Health what improvements he expects choice in the NHS will have for deaf people (a) in arranging an appointment and (b) in communicating with their doctor.
Dr. Ladyman: "Building on the Best: Choice", Responsiveness and Equity in the NHS draws out the main themes that emerged from our recent consultation on what changes would do most to improve the experience of health care for patients, users and carers. Building on the Best confirms that the commitment in the NHS Plan for a national interpreting and translation service has been initiated by NHS Direct. The interpretation component will include a requirement to provide services for people who use British Sign Language. Over time, this contract will be available to help deaf people arrange appointments and communicate with their doctors.
Mr. Chope: To ask the Secretary of State for Health
(1) what information his Department collects in respect of waiting times for audiology services;
(2) which NHS trusts have entered into partnership agreements with private hearing aid dispensers for (a) 2003-04 and (b) 2004-05.
Dr. Ladyman: The Department does not collect centrally information about waiting times for non-consultant led specialities such as audiology, nor about contracts entered into by local services.
The national framework agreement awarded to David Ormerod Hearing Centres and Ultravox Holdings plc in October 2003 will provide a service to patients on the same basis as the national health service, which remains responsible for the patients' care. It has so far involved sites in Shrewsbury, Leeds, Bradford, Bath, Bournemouth and East Cheshire. This partnership agreement is now being rolled out nationally
Commons Written Answers (19 Jan 2004)
Sign Bilingualism
Jon Trickett: To ask the Secretary of State for Education and Skills what steps his Department is taking to secure universal access for deaf children to Sign Bilingualism; and if he will make a statement.
Mr. Miliband: Last March the Government issued a position statement recognising British Sign Language (BSL) as a language in its own right and announcing that it would make available £1 million for a discrete programme of initiatives to support the statement. A working group comprising key Government Departments and organisations for deaf people has been established to advise on priorities for allocating the funding. Tenders are currently being sought for work which will contribute to establishing a Great Britain wide framework to support the recruitment, training and deployment of BSL tutors and for work which will promote access for BSL users through awareness-raising amongst employers, service providers and in the wider community. The working group will also be considering strategies and policies which overtime will further increase access to BSL and will be making recommendations to Ministers in the autumn.
Parents of deaf pupils who have statements of special educational needs, are able to express a preference for the maintained school they would like their child to attend, and can also make representations for a place at an independent or non-maintained special schools. Before expressing a preference they are able to consider communication approaches offered by different schools - auditory-oral, total communication or sign bilingualism.
Commons Written Answers (20 Jan 2004)
Lesser-used Languages
Mr. McNamara: To ask the Secretary of State for Northern Ireland what his estimate is of the number of speakers of (a) each European lesser-used language and (b) other languages used in Northern Ireland.
Angela Smith: The following table provides details of speakers of lesser-used languages recognised under the Council of Europe's Charter for Regional or Minority Languages:
Language Speakers Source and comments
Irish 106,844 Persons aged three and over (NI census, 2001). In total 167,490 persons have 'some knowledge' of Irish
Ulster-Scots 35,000 Approximate, based on 2 per cent. of population. (NI Life and Times Survey, 1999)
We have no information on the number of users of other European lesser-used languages. I estimate their numbers to be minimal.
The approximate numbers of speakers of other languages used in Northern Ireland are as follows:
Language Speakers Source and comment
English 1,700,000+ All Irish and Ulster-Scots speakers are bilingual. See "In other words", Daniel Holder (2003) for information on knowledge of English among speakers of other languages
Chinese 4,200 Various dialects are spoken. NI census (2001) recorded 4,200 people of Chinese ethnic origin. Holder (2003) estimates 8,000
British Sign Language 3,000 British Deaf Association
Irish Sign Language 1,500 British Deaf Association
Cant/Shelta/Gammon 1,700 Oral languages of the Irish Traveller Community Holder (2003), Kirk and O Baoill (2002)
Arabic 1,000-1,500 Holder (2003), Modern Standard Arabic, also including speakers of Western and Eastern Arabic
Portuguese 1,000+ Holder (2003)
Tagalog 600 Holder (2003) (National Language of the Philippines)
Bengali 450-500 Holder (2003)
Hindi or Punjabi 1,700 Holder (2003)
Southern Indian Languages 500 Holder (2003) includes Tamil, Kannada, Kanta, Malay ala, Marati, Oriya and Telugu
Farsi 350 Holder (2003)
There are also smaller numbers of other language speakers such as Albanian; Turkish; African Languages such as Swahili; Afghani; Russian; Japanese; Hebrew; Korean; Vietnamese; Mallayo; Thai and speakers of other European Languages such as French and Spanish (both from those countries and from other countries where those languages are spoken). In total there are over 70 minority ethnic languages spoken in Northern Ireland (Holder, 2003).
Commons Written Answers (21 Jan 2004)
Civil Service (Disabled People)
Mr. Goodman: To ask the Chancellor of the Exchequer if he will set out the
number of employees in his Department who have a disability, broken down by
disability type.
Ruth Kelly: 5,247 of the 98,770 staff employed by the Treasury, Inland Revenue
and HM Customs and Excise have declared a disability.
Number
HM Treasury
Capacity 10
Co-ordination 7
Hearing 9
Learning 4
Mentally ill 1
Mobility 7
Speech 2
Visual 4
Total number 44
HM Customs and Excise
Hearing Impairment - and other 20
Hearing Impairment - alone 110
Learning difficulties - alone 23
Learning difficulties - and other 7
Mental illness - alone 32
Mobility impairment - and other 48
Mobility impairment - alone 126
Physical coordination - alone 31
Physical coordination - and other 22
Reduced phys. Capacity - and other 70
Reduced phys. Capacity - alone 256
Severe disfigurement - and other 1
Severe disfigurement - alone 1
Speech impairment - and other 2
Speech impairment - alone 8
Status unknown 43
Unknown disability 106
Visual impairment - and other 16
Visual impairment - alone 61
Total number 983
Inland Revenue
Unknown disability 1,126
Reduced physical capacity 729
Visual impairment 668
Mobility impairment 651
Hearing impairment 625
Mental illness 242
Learning difficulties 72
Speech impairment 46
Physical co-ordination difficulties 43
Severe disfigurement 11
Obsolete descriptions 8
Total number 4,220
Grand total 5,247
Commons Written Answers (21 Jan 2004)
NORTHERN IRELAND - Civil Service (Disabled People)
Mr. Goodman: To ask the Secretary of State for Northern Ireland if he will set out the number of employees in his Department who have a disability, broken down by disability type.
Mr. Pearson: Of the 32,384, staff employed by the Northern Ireland Civil Service and the Northern Ireland Office, 1,277 (3.9 per cent.) declared a disability. The breakdown by disability type is:
Type of disability Number
Hearing impairment 189
Visual impairment 57
Speech impairment 43
Mobility impairment 157
Physical co-ordination difficulties 39
Reduced physical capacity 326
Severe disfigurement 17
Learning difficulties 20
Mental illness 96
More than one disability 326
Type of disability not specified 7
Total 1,277
Commons Written Answers (22 Jan 2004)
Disability Discrimination Act
Tim Loughton: To ask the Secretary of State for the Home Department what incentives he is giving trusts to stay within the requirements of the Disability Discrimination Act 1995 not to discriminate against deaf people in terms of equitable access.
Dr. Ladyman: I have been asked to reply.
Trusts are responsible for fulfilling the requirements of the Disability Discrimination Act 1995 (DDA), including the provision of equitable access for deaf people. There are a number of means by which the Department and others continue to help them.
In 1999, the National Health Service Executive issued management guidance to NHS trusts, health authorities and primary care groups in implementing Part III of the DDA and a guide "Doubly Disabled" was published to increase managers' and staff's awareness of disabled people.
Currently, the Department is developing with the Disability Rights Commission a framework for partnership action on disability, which identifies key areas for joint action. This will deliver real improvements for disabled people as users and providers of health and social care. Access and communication has been identified as a priority and the Department is establishing a working group to oversee a range of initiatives on access, including the production of sector-specific guidance on good practice, and a programme to promote awareness of the access duties set out in the DDA. The NHSU is also working closely with the Disability Rights Commission and others to develop a framework and programme to address training on disabilities issues in health and social care.
Commons Written Answers (26 Jan 2004)
Mental Health
Sandra Gidley: To ask the Secretary of State for Health what estimate he has made of the number of people aged 65 years and over who suffer from sensory impairment, broken down by sense.
Dr. Ladyman: The Department collects statistics on the numbers of people in England who are registered with councils as blind, partially sighted, deaf and hard of hearing. The numbers of people over 65 years so registered, as at 31 March 2003, were: blind-121,115; partially sighted-22,165; deaf-19,030, hard of hearing-116,070. Registration is voluntary.
Commons Written Answers (26 Jan 2004)
Digital Hearing Aids
Mr. Chope: To ask the Secretary of State for Health pursuant to his answer of 5 January to questions, reference 145050 and 145051, if he will list those audiology departments in England that do not fit digital hearing aids routinely.
Dr. Ladyman [holding answer 13 January 2004]: The Department of Health does not hold centrally a list of audiology departments in England. However, details of those audiology departments that are or will be involved in the modernising hearing aid services project are available at www.mhas.info. Details have been placed in the Library.
Commons Written Answers (26 Jan 2004)
Civil Service (Disabled People)
Mr. Goodman: To ask the Secretary of State for Health if he will set out the number of employees in his Department who have a disability, broken down by disability type.
Ms Rosie Winterton: The information requested is shown in the following table:
Disability broken down by disability type, Total number of employees
Visual impairment, 20
Hearing impairment, 30
Speech impairment, 3
Walking impairment, 13
Physical co-ordination impairment, 26
Reduced physical capacity, 26
Severe disfigurement, 1
Learning difficulties, 3
Mental illness, 21
Progressive conditions, 20
Neurological conditions, 12
Other (This figure refers either to an unspecified disability or a disability that is outside of the categories for which data is collected), 28
Staff in the Department provide information on disability on a voluntary basis so the figures in the table may not reflect the total number of staff who have a disability.
Commons Written Answers (26 Jan 2004)
Civil Servants (Disabilities)
Mr. Goodman: To ask the Secretary of State for Trade and Industry what progress has been made in meeting targets for the proportion of people with disabilities in senior posts in her Department.
Ms Hewitt: In 2000, benchmarks for staff with disabilities in DTI were set across all grades. Targets set internally for staff in senior civil service were:
Year, Benchmark for SCS posts (Percentage)
2000 (base year), 3.8
2002, 3.9
2004, 4.2
2005, 4.7
The Cabinet Office publishes statistical information about senior civil servants with disabilities on its website http://www.civilservice.gov.uk/statistics/documents/pdf/disability-pct03.pdf. This shows that as of 1 April 2003, 4.0 per cent. of DTI HQ staff in the senior civil service had a disability.
I have recently launched the DTI Disability@Work strategy to further improve career opportunities for staff with disabilities. I expect this will benefit staff at all levels and help increase our representation throughout the grades over time.
Mr. Goodman: To ask the Secretary of State for Trade and Industry if she will set out the number of employees in her Department who have a disability, broken down by disability type.
Ms Hewitt: The information requested is in the following table:
Type of disability, Number of staff as of 1st January 2004
Hearing impairment, 33
Visual impairment, 23
Speech impairment, Five or less individuals; the DTI code of practice precludes
us from reporting the numbers to preserve confidentiality.
Learning difficulty, 5
Mental illness, 13
Mobility impairment, 70
Physical co-ordination, 32
Reduced physical capacity, 78
Severe disfigurement, Five or less individuals; the DTI code of practice precludes
us from reporting the numbers to preserve confidentiality.
Other, 29
Total staff with disabilities, 287
Total DTI staff, 4,031
Commons Hansard (27 Jan 2004)
Audiology
Mr. Christopher Chope (Christchurch) (Con): The NHS audiology service is in crisis. Although the Government have decided that digital hearing aids should be available to all by April 2005, freely at the point of need, they are manifestly failing to deliver the means necessary to achieve that objective.
I make no apologies for illustrating the depth of the crisis by referring to the situation in Christchurch, east Dorset and Bournemouth. More than 7,000 people are waiting for a hearing aid assessment at the East Dorset audiology centre, which is run by the Bournemouth primary care trust. In the last period for which figures are available, between April 2003 and November 2003, the East Dorset audiology service carried out 177 hearing aid assessments a month and 150 hearing aid fittings a month. Unless something dramatic happens, those who join the waiting list for a hearing aid assessment now will have to wait well over three years before it is conducted. Even the waiting lists for those in greatest need - those aged over 90, those who have no hearing whatsoever and those who are war pensioners - is one year just for a hearing assessment. There is then a further period of around six months before hearing aids are fitted.
It will not surprise you, Mr. McWilliam, that the primary care trust does not publicise the fact that its current waiting time is between three and four years. It cites instead the length of time that a patient being assessed this week has had to wait. That is currently about 18 months, which is bad enough, but if a person joins the waiting list today their wait will be more than 39 months, unless something dramatic happens as a result of this debate.
I hope that the Minister will confirm that she believes, as does the primary care trust in Bournemouth, that waiting times are unreasonable and excessive. If she does not agree, can she explain the finding of the health service ombudsman in the complaint against Southampton University Hospitals NHS Trust that
"it is unacceptable for patients to wait two years for a hearing assessment."
She will be familiar with that case, which is cited in the latest summary of the ombudsman's cases. If it is unacceptable for a patient to wait two years for a hearing assessment, how much more unacceptable is it that they should have to wait more than three years? If she does agree that the current waiting times are unacceptable, I challenge her to tell us what the Government intend to do to address the crisis.
One of my frustrated constituents wrote to the Prime Minister about the situation on 22 May 2003. He received a response three months later from the Department of Health, expressing horror at his hearing problems and appreciating his concern at the length of time that he had had to wait for an audiology appointment. The Department of Health official said:
"Let me assure you that the Government shares your concerns about waiting times. Their vision is to provide patients with fast and convenient access to health care wherever they use the system ... Thanks to the continued hard work of staff across the NHS, steady progress has already been made. Maximum waiting times have already been reduced to twenty one weeks for a first outpatient appointment".
That was totally misleading. The waiting time for audiology services locally is increasing, rather than decreasing, and is now seven or eight times the maximum referred to by that Department of Health official in the name of the Government.
Good hearing is fundamental to the quality of life. Elderly people in particular should not have to wait years to gain access to a service that is immediately available in most high streets, albeit at a price that for many is unaffordable. In audiology, as in so many other policy areas, there is a growing chasm between what the Government have promised and what is actually being delivered. One straightforward way of improving matters would be for the Government to pay for any NHS patient who has not received an out-patient hearing assessment within six months to have the service provided at NHS expense with a registered private practitioner.
In a written parliamentary question, I asked the Minister's colleague, the Under-Secretary of State for Health, the hon. Member for South Thanet (Dr. Ladyman), about the possibility of that happening, but he did not give me the courtesy of a straight answer. I hope that the Minister will remedy that situation today and will not fall back on the notion that a private sector partnership initiative, conducted by the Bournemouth primary care trust, is sufficient to deal with the backlog. In the past five months alone the backlog for Bournemouth has increased from about 5,000 to 7,000 cases, despite 300 patients benefiting from a private sector partnership. There are plans to provide a further 700 patients with treatment under a private sector arrangement next year, which I welcome, but that will make only a small dent in the backlog.
One of my constituents sent me a copy of the RNID leaflet for deaf and hard-of-hearing people entitled "A Good Audiology Service: What You Can Expect". Page 5 of that leaflet says that waiting times should not exceed the following:
"From date you are referred to your GP to date of first visit or assessment not more than four weeks. From assessment visit to first hearing and fitting appointment not more than four weeks."
I wrote to the chief executive of the RNID, Dr. John Low, about this. In his charming reply, he said:
"'A Good Audiology Service' outlines what audiology services should work towards, and what patients should be able to expect but does point out that not all services are able to deliver to this level at the current time."
On present trends, the East Dorset audiology service will never be able to meet the RNID aspiration - that is unless the RNID changes its aspiration from four weeks to four years.
I have attempted to ascertain whether the situation in my locality is unique or whether members of the public seeking access to NHS audiology services elsewhere in the country are experiencing similar delays. It appears, however, that the Government refuse to collect any statistics on the subject, despite having been advised most strongly so to do by the Audit Commission in its report "Fully Equipped" of March 2000.
On 5 January, the Minister's colleague, the Under-Secretary of State for Health, the hon. Member for South Thanet, assured me that
"all audiology departments in England will be fitting digital hearing aids routinely by April 2005." - [Official Report, 12 January 2004; Vol. 416, c. 593W.]
I then asked him if he would list those audiology departments that do not fit digital hearing aids routinely at present. On 26 January, he replied that the Department of Health does not hold centrally a list of audiology departments in England.
That is bizarre. The Minister's colleague purports to speak for all audiology departments, but when he is pressed he is unable even to list them. Will the Minister undertake to start collecting information about NHS audiology services so that she is able to back up policy assertions with facts?
I share the belief of the RNID that waiting times for audiology services suffer from not being part of the national standards for waiting times. Pressure is put on local health trusts to satisfy national standards for services other than audiology to the inevitable detriment of that service. It is well established that centrally imposed targets distort clinical priorities. Therefore, the target system should either be abandoned or it should embrace audiology. Does the Minister regard NHS audiology services as an issue of national, or only of local, importance?
On 20 January, in a written answer to a question of mine about audiology departments, the Minister's colleague said:
"It is for primary care trusts to plan these services in response to the needs of their local communities." - [Official Report, 20 January 2004; Vol. 416, c. 1105W.]
Is that the full extent of ministerial involvement?
It is estimated that 8.7 million people in the UK are deaf or hard of hearing. Currently, about 2.7 million of them have a hearing aid. The Medical Research Council has estimated that a further 3 million people would benefit from wearing one. If a national health service means anything, surely it should embrace a national plan for responding to the hearing needs of the people?
On 18 December, I asked the Minister's colleague to list, in respect of each primary care trust, the number of people waiting for a hearing assessment and the number waiting for more than six months. He responded:
"there are no targets for waiting times for audiology services". - [Official Report, 5 January 2004; Vol. 416, c. 175.]
However, he also felt confident enough to say that the Government are taking action to tackle the causes of longer waits. It is well known that if something cannot be measured, it cannot be controlled. The reality is that the waits are becoming significantly longer rather than shorter.
As with so many other taxpayer-funded services, the Government are quick to brag about the financial inputs but seem far less concerned about the outputs. What is unreasonable about my suggestion that all those waiting for more than six months should be able to elect the private sector option to be paid for by the NHS? What about my suggestion that the NHS should pay for those who obtain digital hearing aids on the continent? The RNID members' magazine includes glowing reports on how UK customers can have their digital hearing aids fitted to a very high standard in Denmark at a cost far lower than in a UK high street and at a time when they need them rather than three or four years later. There is much anecdotal evidence that people are organising trips to Denmark so that they can access audiology services, which should be available to them in this country and provided by the NHS.
On 6 February 2003, the then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), issued a press release entitled "Digital Hearing Aids available to all by April 2005". We may come to regard that headline as one of the most misleading ever issued. His words must have been calculated to fill a million hearts with hope. He raised expectations by saying:
"These digital hearing aids cost the NHS up to £75 per aid and will be free to all NHS patients. Similar products currently cost people purchasing privately around £2,000."
The RNID described the announcement as brilliant news and emphasised that digital hearing aids offer patients a 40 per cent. improvement in hearing and an improved quality of life.
Unless the Minister intervenes, digital hearing aids will only be available to my constituents by April 2005 if they applied in 2002. Does she think that that was what the then Secretary of State had in mind when he issued that press release on 6 February 2003? We must ensure that the reality is changed to match the rhetoric, otherwise the headline "Digital Hearing Aids available to all by April 2005" will remain a cruel deception and an indictment of this Government's integrity.
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate the hon. Member for Christchurch (Mr. Chope) on securing today's debate. I know that he has shown a great deal of interest in this important topic, and the Government share that interest. We are investing £94 million in audiology services in this financial year and the financial year 2004-05, in addition to more than £30 million that has already been invested and that will help us to ensure that by March 2005-as he remarked-every audiology department in England will routinely fit digital hearing aids as part of a modernised audiology service.
The hon. Gentleman raised some important issues, and I hope to put them into the context of the situation in England. The progress on modernisation of hearing aid services is good news for everyone with hearing loss. That is something that will affect most of us as we grow older-if it has not already done so. I am pleased to be able to say that to date more than 140 NHS audiology services have been, or are in the process of being, modernised. Fewer than one third of the services in England still need to be modernised and we are on target to deliver fully modernised audiology services in the whole of England by March 2005. Therefore, I hope the hon. Gentleman will accept that we have a national interest in the matter. He questioned that earlier.
Mr. Chope: How is it that the Minister's Department does not have a list of all the audiology departments in the NHS?
Miss Johnson: I do not have the details of the answer to that question, but I can tell the hon. Gentleman that the arrangements on this matter are being rolled out through a contract with the RNID, as he knows. We are working with it closely.
Modernisation of hearing aid services is an NHS success story-both for services and for patients, who are getting a better service. Let us not forget that providing an aid is not a simple process. The hon. Gentleman did not talk much about that process, but I think it is worth while bearing it in mind. A first visit in that process involves the following: a hearing test; talking to the person about hearing in everyday situations to help decide the appropriate aid; taking a mould of the ear; and discussing attitudes to using an aid. Later, there is a visit for fitting the aid and a further one to check that all is well and to provide training, if necessary, in the use of the aid.
In some respects modernisation makes services a victim of their own success. In areas where digital aids are already available, an increase in demand has often been noted. That, together with the increased time that it takes to assess for and to train in the use of digital aids, puts pressure on the waiting times. As I have outlined, this is not just about giving a patient a digital hearing aid and hoping for the best. The audiologist needs to spend more time with the patient to ensure that the aid is fitted and programmed properly to meet that particular patient's needs. Therefore, we have been considering ways to increase the capacity in audiology services. I should like to talk about two of those.
The first is the "Hearing Direct" pilot, a partnership with the high street suppliers, Ultravox and Ormerod. "Hearing Direct" is a way to reduce waiting times in and pressure on audiology departments. It is being piloted at four sites throughout the country-in Chester, Exeter, Leicester and Cambridge. Under that scheme, people can use a telephone information line that gives details of local services. Patients receive a telephone call eight to 12 weeks after the fitting to assess their progress and decide whether they need another visit to the audiologist.
The national framework agreement awarded to David Ormerod hearing centres and Ultravox Holdings plc in October 2003 enables them to provide a service as an extension of the modernised NHS service. I emphasise the fact that the NHS remains responsible for the patient's care. So far that agreement involves sites in Shrewsbury, Leeds, Bradford, Bath, east Cheshire and Bournemouth. That partnership is being rolled out nationally and all modernised sites have been invited to apply for funding to implement it.
In terms of capacity, it is important that we recognise that not everyone in England is yet able to access a modernised service and there are, in certain places, pressures on services. Those pressures can best be reduced by capacity-building initiatives, such as those that I have already mentioned. In the longer term, we are addressing the recognised shortage of audiologists by establishing new degree courses.
Perhaps I should now deal with the hon. Gentleman's constituency. Waiting times for hearing aids in East Dorset have historically been longer than anyone would wish, but steps are in place to reduce them. East Dorset was the recipient of one of the second wave modernising hearing aid services in 2002-03. It has been involved in the extended learning pilot of the partnership agreement to provide NHS hearing aid services through a high street hearing aid company with an outlet in Bournemouth. Some 300 patients in East Dorset are currently being seen as part of the extended pilot. We expect a further 700 patients to be seen by March this year.
I anticipate that if a service supplying analogue aids to a small number of patients via a GP's surgery wishes to be able to prescribe digital aids, that would be a matter for the surgery and the local primary care trust. There are principles that I would expect the primary care trust to apply when considering whether to support such a development, including whether the service meets the same standards as the mainstream NHS audiology services, whether it unfairly advantages some patients over others, and whether it provides value for money.
The situation in Bournemouth is causing concern, particularly for the hon. Gentleman. I was interested in his remarks on measuring and controlling things. On the one hand he seemed to say that targets are a good idea, but on the other he suggested that we should not have them, and that we are always being told that we have too many targets. However, I think I heard him suggest another target.
Mr. Chope: I drew to the Minister's attention a specific recommendation from the Audit Commission in 2000 that her Department should collect data to inform itself about the state of audiology services. It is obvious from her weak response to the debate that she has manifestly failed to do that.
Miss Johnson: The hon. Gentleman's remarks lead me nicely into my second point on targets. The hon. Gentleman will, on other occasions, say that there is too much bureaucracy and too many demands on people to fill in forms. The only way in which information can be collated is if it is collected locally and sent to the centre. The hon. Gentleman and his party spend much time grossly exaggerating the number of administrators in the NHS, while taking us to task for so-called bureaucracy and administration costs. However, he is again proposing another area in which we have more administration.
The Bournemouth teaching primary care trust is concerned about the unacceptably long waiting times for audiology and is preparing an action plan to reduce those, which will include the following measures: it will ensure that guidelines are serving the modern hearing aid services appropriately and making good sense in their application; it will consider ways to minimise the patient journey time for experienced users in discussion with staff and users; it will continue with its existing programme of overtime working; and it will consider pursuing further the use of public-private partnership initiative action to address the shortfalls in the area.
As I said, there is a history of problems. If we consider the overall success nationally, I remind the hon. Gentleman that more than 140 sites and more than two thirds of NHS audiology departments in England have already been modernised or are in the process of being modernised. That is in distinct contrast to four years ago, when the NHS used 1970s technology to fit analogue hearing aids, many of which remained unused. The Department of Health had to intervene to help trusts bring audiology services up to date, which is another clear indication that we accept our national responsibilities while making it very clear through the shifting of the balance of power programme that the responsibilities for delivery at local level lie with local commissioners and local deliverers-namely, the PCTs and those who actually deliver the services.
Mr. Chope: Is the Minister saying she does not believe that she can do anything to reduce the waiting times? I have already told her that patients will have to wait for between three and four years if they apply today for an assessment.
Miss Johnson: It is clear that the Department monitors the performance of commissioners and providers in the NHS through the strategic health authorities. At SHA level and at the level of commissioners, as I have outlined, action is already being taken to address the shortfalls in the hon. Gentleman's constituency and related areas. The action plan to reduce waiting times, which I outlined a moment ago, is being drawn up on that basis.
We have put measures in place to modernise hearing aid services. By March 2005, every audiology department in England will provide the modernised services. To make that possible, the Government have provided central funding for new equipment and to train staff to use it. As I said, training patients to use the new aids incurs additional time costs. We hope that PCTs throughout the country will continue to commission and provide the excellent service that we know is possible.
It is worth briefly mentioning the price of hearing aids. The hon. Gentleman referred to the then Secretary of State's press notice when the digital hearing service was announced. We have driven a hard bargain to reduce significantly the price of digital hearing aids, so that they are now available to the NHS at highly competitive prices. I am sure that the hon. Gentleman will accept that in the light of the comparison that he mentioned. Those prices helped us to make it possible to spread the benefits of the hearing aids much more widely and quickly. They will also make it easier for PCTs to fund them after March 2005. After that time, I would not expect anyone to receive an analogue hearing aid, except for clinical reasons. It might be worth mentioning that some people hear better with analogue aids than with digital ones. As the hon. Gentleman remarked, it is true that the aids are provided free of charge to patients.
I mentioned the collaboration with the RNID to modernise the services. Through that collaboration, the Department of Health learned many valuable lessons about working with the voluntary sector. It also showed the Department of Health and other Departments a way of finding solutions to other difficult problems. When we set out to modernise audiology, the RNID might have called itself one of our fiercest critics, yet the project has shown that even our critics can help us to improve the things that we do and to move towards providing services that are much more responsive to the needs of consumers.
Mr. Chope: I am grateful to the Minister, who has been very generous in giving way. I kept my remarks short partly so that we could have this exchange.
Would the Minister be willing to receive a deputation from the East Dorset audiology centre in my constituency? This is almost a dialogue of the deaf. I keep asking what we are going to do about people who are waiting for between three and four years, and the Minister keeps coming out with a whole load of statistics that have no bearing on the plight of my constituents who are eager to get access to these services. We are talking not only about people who need a hearing aid, but about people who suffer from tinnitus, for example, which is a very disabling condition, as the Minister will know. Would she be willing to experience through a deputation exactly what it is like in east Dorset, and to discuss with local people how the Government and East Dorset might work together to try to achieve a solution that is in the interests of everybody living in the area? Would she also accept that the criticisms that I have voiced are not mine alone? They are shared by the RNID, which is as frustrated as I am on behalf of my constituents. We all want progress.
Miss Johnson: It is not for me to suggest to the hon. Gentleman how he might work with his local services. However, if it were my constituency, I would first address the issues with the primary care trust, looking in detail at its action plan and meeting members of senior management to talk about the issues with them and with users. He might want to pursue that locally. The Under-Secretary of State for Health, my hon. Friend the. Member for South Thanet (Dr. Ladyman), has the most direct responsibility for the service. Local issues can only be addressed locally. Given that the majority of funding is now with the PCTs and that extra money is being rolled out through the modernisation programme to support the development of digital hearing aid services, it is not for us to dictate the detail or to direct how the expenditure is deployed.
Mr. Chope: In that case, will the hon. Lady give some advice in her position as a Minister, albeit not the Minister with responsibility for audiology? Will she publicly advise all the PCTs that have waiting lists in excess of 18 months that that is totally unacceptable, and tell them that something must be done to reduce them to a reasonable level?
Miss Johnson: We can consider the matter of PCTs with longer waiting lists, but there might be reasons for their being in that position-they might have started from a low base, as was the situation in Dorset, with long waits the norm. There is also the time it will take and the training that personnel will inevitably require in order to implement new services. If the hon. Gentleman has explored all the options locally and believes that there is a role for the Department, I am sure that my colleague will consider carefully any request that he might make for a meeting on such a topic. It is important to recognise that we are not in a position to direct individual PCTs with devolved funding and devolved responsibilities on how best to run their services. Investigating problems locally is the most fruitful way forward-PCTs have both the money and the expertise to decide what to do.
In conclusion, audiology services in the NHS are a success story. We have improved services beyond recognition since the first pilots of digital hearing aids in 20 locations in September 2001. We have initiated degree courses to train new audiologists, we have brought down dramatically the prices of digital hearing aids and we have engaged with the voluntary sector, manufacturers and high street providers. The modernised services that are in place in most of England, and that will cover all of it by March 2005, are good news for everybody with hearing problems. As we get older, it will be good news for all of us.
Question put and agreed to.
Adjourned accordingly at twenty-eight minutes past Four o'clock.
Commons Written Answers (29 Jan 2004)
Digital Hearing Aids
Mrs. Iris Robinson: To ask the Secretary of State for Northern Ireland how many individuals were provided with digital hearing aids in 2003; and what estimate he has made of how many others would benefit from these devices.
Angela Smith: The phased introduction of Digital Hearing Aids (DHAs) commenced in October 2003. Information on the provision of hearing aids is not collected routinely by the Department. Health and Social Services Trusts with Audiology departments will shortly be asked to provide information on the provision of DHAs for the period October 2003 to the end of January. Information will thereafter be collected on a quarterly basis.
It is estimated that there are over 100,000 hearing aid users in Northern Ireland. Research suggests that digital hearing aids (DHAs) may benefit 80 per cent. of hearing aid users.
Commons Written Answers (30 Jan 2004)
Sign Language
Mrs. Iris Robinson: To ask the Secretary of State for Northern Ireland how many individuals in Northern Ireland are trained in sign language.
Angela Smith: There are 17,000 people in Northern Ireland who have severe or profound deafness. Approximately 4,500 of these people use sign language. Hearing people who associate with signers in business or personal life also use sign language. Statistics are not available on how many individuals are trained in sign language, however, there are currently only five fully qualified registered BSL interpreters in Northern Ireland and one ISL interpreter.
The Council for the Advancement of Communication with Deaf People (CACDP) in Northern Ireland have provided details of the BSL and ISL training given at each level from 2000 to 2003.
British Sign Language Level 1, Year 2000, 456, Year 2001, 592, Year 2002, 522,
Year 2003, 386
Irish Sign Language Level 1, Year 2000, 63, Year 2001, 60, Year 2002, 32, Year
2003, 27
British Sign Language Level 2, Year 2000, 72, Year 2001, 60, Year 2002, 81,
Year 2003, 84
Irish Sign Language Level 2, Year 2000, 12, Year 2001, 16, Year 2002, 20, Year
2003, 13
Total: Year 2000, 603, Year 2001, 728, Year 2002, 655, Year 2003, 510
Commons Written Answers (30 Jan 2004)
Industrial Injury Disablement Benefit
Mr. Gibb: To ask the Secretary of State for Work and Pensions what the procedures are for claiming industrial injury disablement benefit; and if he will list the claim forms required.
Mr. Browne: A person wishing to claim Industrial Injuries Disablement Benefit (IIDB) in respect of an industrial accident or a prescribed disease should, in respect of an industrial accident, fill in Bl 100A and, in respect of prescribed diseases, Bl 100B for all diseases apart from Chronic Bronchitis and Emphysema (Bl 100C); Allergic Rhinitis (Bl 100E); Occupational Asthma (Bl 1000A); Occupational Deafness (Bl 1000D); and Pneumoconiosis, Byssinosis or asbestos related diseases (Bl 100PN).
An appropriate advice leaflet from the series SD6/7/8 will also be sent; a person wishing to claim IIDB should complete the appropriate form and forward without delay to their local Social Security office.
Copies of all forms referred to are in the Library.
Commons Written Answers (30 Jan 2004)
EDUCATION AND SKILLS
Civil Servants (Disabled People)
Mr. Goodman: To ask the Secretary of State for Education and Skills if he will set out the number of employees in his Department who have a disability, broken down by disability type.
Mr. Charles Clarke: My Department is an active member of the Cabinet Office led Civil Service Disability Working Group, which was set up in January 2003 to look at disability collection issues, monitoring and non-declaration.
Over 5 per cent. (280) of staff employed in my Department have recorded a disability.
Information on the numbers by type of disability is set out in the table. Details are not published where the numbers are below five in order to protect the privacy of the individual, in line with Exemption 12 of the Code of Practice on Access to Government Information.
Disability type, number
Hearing impairment, 43
Learning difficulties, 7
Mental illness, 5
Mobility impairment, 47
Physical coordination difficulties, 5
Reduced physical capacity, 51
Visual impairment, 20
Unknown disability, 66
The statistics exclude DfES staff in the Government Office network with a recorded disability where a breakdown by disability type could be obtained only at disproportionate cost.
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