Westminster Debate on Deafness

Posted by 616 on July 20, 2016

Westminster Debate on Deafness

July 20, 2016 at 11:54 AM

Jim_Fitzpatrick_MP_.jpgJim Fitzpatrick MP at the recent launch of the Commissioning Framework

Jim Fitzpatrick MP (Lab, Poplar and Canning Town) has led a Westminster Hall debate on NHS England's Action Plan on Hearing Loss and the forthcoming publication of the Commissioning Framework for Hearing Loss Services.

The full proceedings can be read online but a summary from UK Council on Deafness is below. Link to full proceedings

Jim Fitzpatrick, who Chairs the All Party Parliamentary Group on Deafness, used his speech to set out the evidence on the prevalence and impact of hearing loss. He also noted research from Action on Hearing Loss which found that people wait an average of ten years to seek help after noticing the first symptoms of hearing loss.

The Minister for Community and Social Care, Alistair Burt MP (Con, North East Bedfordshire) responded to the debate for the Government.

Jim went on to outline a number of issues on which he wanted the Government Minister responding to the debate to cover – including

  • the rationing of hearing aids,
  • the potential for a national screening programme 
  • the recognition for British Sign Language.

The previous Chair of the All Party Group, Lilian Greenwood MP (Lab, Nottingham South) also addressed the issue of rationing and the impact of budget cuts to NHS audiology services, saying: "We are also very concerned, of course, about the risk of rationing access to hearing aids, as local health commissioners' budgets are under intense pressure. In fact, the report on NHS audiology across the UK published by Action on Hearing Loss and entitled "Under Pressure", showed that 30% of NHS audiology providers had had their budgets reduced. Along with increased demand, that had led to two fifths of providers making service reductions, resulting in longer waiting times, fewer follow-up appointments and reduced availability of home visits. In a small number of cases, providers were not providing two hearing aids to patients with hearing loss in both ears. "Worse still, as everyone is aware, North Staffordshire clinical commissioning group decided in March last year to stop funding free NHS hearing aids altogether for those with mild heang loss. 

There was a fear that others would follow it in doing that, but so far, as a result of significant campaigning by Action on Hearing Loss and many others, that has not happened.

South Staffordshire, South Norfolk, Kernow and Mid Essex CCGs, which had all signalled their intention to restrict hearing aid provision, have now decided otherwise, or have at least delayed a decision until the national commissioning framework is published.

However, three CCGs in Worcestershire are currently consulting on potential changes to local health services— including a proposal to cut NHS hearing aid provision; so there is still a threat to services."

Labour's Shadow Health Secretary, Diane Abbott MP (Lab, Hackney North and Stoke Newington) welcomed the Action Planning on Hearing Loss and highlighted the importance of reducing the impact of stigma.

Speaking on the rationing of Hearing Aids she said: "The question of hearing aid rationing arises in the context of pressure on NHS resources. One way in which the NHS and CCGs are seeking to manage the pressures is by raising the bar before someone can get access to a service or to help. One of the most alarming aspects of that approach is its effect in mental health, where people must manifest more extreme symptoms before they can get help. It might seem to CCGs that rationing hearing aids is a less obvious form of rationing, because only the patients know or understand what has happened. Thus, as we have heard, since October 2015 one CCG—North Staffordshire—has stopped providing hearing aids to patients who have mild hearing loss, and it subjects those with moderate hearing loss to a questionnaire before it decides whether to provide them with a hearing aid. "As the Minister heard from my colleagues, it is not acceptable to ration hearing aids in that way. There is a danger that people's hearing loss will get more severe before they can get the help they need.

There are some exemptions, such as for people with dementia; hearing loss can make people more susceptible to dementia, physical disability or tinnitus. However the approach in question is not good enough. If the Government feel that we must have rationing in the NHS, we need clarity about that—it must be transparent and there must be debate. It cannot happen just because the Government feel that somehow they can get away with it." She also outlined the case for a programme of hearing screening, saying: "The charity Action on Hearing Loss commissioned a cost- benefit analysis of hearing screening, which found that screening everyone and providing support to those who need it at the age of 65 would save £2 billion over 10 years, for a cost of only £255 million. Low levels of diagnosis mean that two thirds of people are not getting the treatment and support they need.

The research suggests that there is an average 10-year delay in people seeking help for their hearing loss and that, when they do, GPs fail to refer fully 45% of those reporting hearing loss to hearing services."

The Minister for Community and Social Care, Alistair Burt MP (Con, North East Bedfordshire) responded to the debate for the Government.

He sets out the purpose of the Action Plan on Hearing Loss, saying: "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."

He also went on to highlight the problem of people delaying seeking help for their hearing loss and the low level of referrals by GP – which is an issue he said he would look at further research on.

On the key issue of rationing, he said: "I am aware that NHS England supported a recent decision from North Staffordshire CCG because it was able to demonstrate that its commissioning policy was evidence-based and had followed extensive public engagement. The hon. Member for Nottingham South was right to say that I am extremely wary of rationing early intervention and hearing aids at the very early stage. I fully accept all the evidence that says that it is doing something at that early stage that prevents something else later on. As colleagues have said, no one else has yet followed that. There has been a lot of challenge.

It remains possible for NHS England to intervene if it thinks that commissioning has gone badly askew, but for now that has not been followed. "The forthcoming commissioning framework will support CCGs to make informed decisions about what is good value for the populations they serve, using an evidence-based methodology to determine policy. NHS Improvement has received expressions of concern about commissioners reducing prices for audiology services, causing firms to exit those services and
reduced access and choice for patients. So far, except in one case, those allegations have not been substantiated and no formal complaint has been made to enable NHS Improvement to consider taking regulatory action. "NHS England could consider any immediate concerns about a CCG's behaviour at local level under the assurance framework, and there may be scope for NHS Improvement to consider them under the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013, under the pricing rules contained in the national tariff."

In response to the questions raised about screening he reiterated the advice of the National Screening Committee that the evidence did not demonstrate that screening would provide improvement in quality of life compared to other methods of identifying hearing loss.