RNID Hearing Matters Campaign
The final item of business is a members' business debate on motion S3M-3894, in the name of Cathy Jamieson, on the Royal National Institute for Deaf People hearing matters campaign. The debate will be concluded without any question being put.
Motion debated,
That the Parliament welcomes RNID Scotland's campaign, Hearing Matters; notes that there are 758,000 deaf and hard of hearing people in Scotland, the majority of whom are aged over 55; further notes that it takes people on average 10 to 15 years to address hearing loss and that there are around 350,000 people in Scotland who could benefit from a hearing aid but are not currently using one; considers that some GPs in the NHS Ayrshire and Arran area are screening adults for their hearing in the community rather than making a straight referral to audiology or ENT, and believes that hearing loss should be identified and treated at the earliest opportunity and the introduction of hearing screening on the NHS for those aged 55 and over considered.
I thank the members from all parties who have stayed in the chamber for the debate. I thank Mary Scanlon in particular, because I know that she may well have had to be somewhere else but chose to be here.
I am pleased to get the chance to speak on the RNID's hearing matters campaign. My interest in the issue was not prompted by personal expertise or experience; it was triggered by the Co-operative Group's support for the RNID campaign, which made me want to find out more. Frankly, I was very surprised when I realised that there are 758,000 deaf and hard-of-hearing people in Scotland—a significant proportion of the population—many of whom have age-related hearing loss. I was also rather shocked to discover that around 350,000 people who could benefit from a hearing aid do not use one.
More than half of all people aged 60 and over have some noticeable hearing loss, but it can take people up to 15 years to seek help. A United Kingdom study found that one in five people between 55 and 77 has difficult in hearing and one in eight has a hearing problem that causes them moderate or severe worry, but only 6 or 7 per cent of people in that age group have hearing aids.
The RNID launched the hearing matters campaign because of the extent of untreated hearing loss; the campaign calls for hearing loss to be identified and treated at the earliest possible opportunity, and for the Scottish Government to consider introducing hearing screening for everyone over 55.
RNID Scotland's campaign report highlights how untreated hearing loss affects people's lives. For example, arguments in the home can arise over whether the television is too loud and people may not respond when a family member is talking to them. The report also highlights how stress in a family setting decreased after the problem was identified and hearing aids were used.
Why do people not seek help? Sometimes the reason is stigma or a perceived link between hearing loss and ageing, but people may also simply be embarrassed about wearing a hearing aid. Routine hearing screening would encourage people to go for a check in the same way as they get their sight or teeth checked.
Screening for the over-55s could be provided in a community setting, such as a general practitioner's surgery, and could be carried out by practice nurses. That would allow a quick decision on whether a referral to audiology is appropriate. Such an approach is already working in practice. The Isle of Wight Primary Care Trust has purchased several hand-held hearing check devices for use in GP practices. In my local health board area—NHS Ayrshire and Arran—I know that some GPs have also purchased hand-held devices, which they use to make the checks before referring patients on where appropriate.
Such an approach would fit with public opinion in Scotland. When the RNID undertook a survey, it found that some 93 per cent of Scots believe that everyone over the age of 55 should be offered a free hearing test. Some 72 per cent believed that such tests should be available in the community.
The RNID provides a simple telephone hearing check, which is supported, again, by the Co-operative Group. The check takes about five minutes and assesses one's ability to hear someone speaking over background noise. The experience is similar to being in a crowded room. The test is pretty easy to use—I have tried it—and seems a very quick and easy way of identifying potential problems that would allow people to be reassured, as I was, or to know that they should follow up the test by seeking further advice from professionals.
There are still concerns about audiology waiting times. The most recent audit in 2006 found that most health boards exceeded the then standard, which was for a waiting time of less than 26 weeks from referral by a GP to an appointment with audiology services in which a hearing aid is fitted. At that stage, waiting times ranged from 12 weeks in the NHS Dumfries and Galloway area to 92 weeks in the NHS Borders area. Therefore, the announcement in 2007 that audiology would come within the 18-week waiting time target by 2011 was generally welcomed. We had expected to be able to see progress at the beginning of April this year when the information was supposed to be put into the public domain. I hope that the minister will confirm in her speech what progress has been made towards meeting the target and when the figures will be published.
Of course, although waiting times are an important issue—we all agree that it is unacceptable that anyone should wait up to 92 weeks for a hearing aid—so, too, is the quality of audiology services. People need access to timely and relevant information in a format that suits them. On-going support and maintenance of equipment are also vital. Surely it is not too much to ask that a review appointment should be offered to all hearing-aid patients every three years.
RNID Scotland's hear to help project in the Scottish Borders has a full-time member of staff and a team of volunteers who visit people to help them with, for example, cleaning their hearing aids, changing the tubes and batteries and demonstrating equipment that might be of help to people. So far, more than 200 people who previously had no one-to-one support have been helped and more than 300 people have been reached through presentations and events in the Borders area. That experience could be used as a model of good practice in other health board areas, including my own. Indeed, with the RNID being the Co-operative Group's charity of the year, funds that are raised in Scotland will be used to expand the hear to help project to other areas. The Co-op's target is to raise £200,000 by the end of the year, and I understand that it is on track to do that.
In conclusion, let me also make a plea for further research to build on the work that is being done by the institute of hearing research's team based at Glasgow's royal infirmary, led by Dr Michael Akeroyd. That work has helped to improve the care and management of hearing loss, not just in the UK but worldwide. Further research would also build on the RNID's support for 10 years of biomedical research; more than £6.5 million has been contributed to tackling age-related hearing loss, improving hearing aids, developing cochlear implants, restoring hearing and curing tinnitus.
I hope that this debate will highlight some of the issues that people with hearing loss face and how we can develop services that will help them to enjoy a decent quality of life. It would be a major step forward for Scotland to have a routine screening programme for the over-55s, ensuring that hearing loss is identified and treated at the earliest opportunity. For those who have not yet tried out the RNID telephone check, the number is 0844 800 3838. I advise members to take a note of it—it may be useful to them or to someone else whom they know.
As is customary, but also right, I thank Cathy Jamieson for bringing this debate to the chamber. It relates to the sort of important issue that we can overlook if we do not ensure that we pick it up periodically.
The perspective from which I approach the issue is very different from that of Cathy Jamieson. I do so from personal experience, partly because I have some genetic make-up that suggests that I will become deaf, and partly because I managed to damage my right ear, so I use a hearing aid regularly. That has one huge advantage. Everyone should have a hearing aid, because it has a radio setting. If one is outside in a place where the radio loop is working, the eddies work, too, and it is often possible to hear things that people do not realise one can hear. People need to be aware of that.
Those who suffer from mild deafness lose out socially, as they tend to withdraw. Everyone has some experience of family irritations. We know that parents are good at selective deafness, but there is a different kind of deafness that leads people not to engage. I put on record for those who are not aware of it that, when people become just a bit deaf, they lose not the ability to hear but the ability to distinguish—what suffers is the signal-to-noise ratio, if I may use that term. People know that someone is saying something but, if there is any kind of background noise, they find it much more difficult to distinguish what is being said. That is not understood by people who do not suffer from the condition. It is wonderful that we now have hearing aids that are minor computers and are capable of at least trying to distinguish signal from noise, instead of just amplifying everything, which does not help much. Some are better than others. I have a sneaking suspicion that the one that I use is not terribly good; we may have to work on that.
We now have universal screening at birth, and the RNID is seeking routine screening for those who are over 55. I can think of reasons why that may not be the correct answer; I suspect that the minister will have words to say about the matter. However, I do not take issue with the RNID about it. When, in their communication with older people—55 is not old—those in the health system recognise there may be a hearing problem, which is not terribly difficult to pick up, they should do their level best to encourage the folk concerned to go to their GP and to get themselves referred. Perhaps that is the message that we really need to get out in the health profession. It may be a more practical answer than screening.
It is true that stigma is an issue. Self-deception, to which the human animal is particularly prone, is also an issue. People say, "I may be a little bit deaf, but not much." Whatever we do, we need a joined-up approach. I am looking forward to meeting NHS Grampian tomorrow to discover how audiology is progressing in the Grampian area, where I live.
There are a couple of other issues that I would like to raise in the seconds that remain to me. First, in a recent answer to a parliamentary question, I was told that the number of British Sign Language translators is rising and that more are in training. I encourage the minister to ensure that that trend continues, because there are many people who need them. It would be good to have a universal service.
Secondly, I recently had an intern do some work for me on the funding of services for people who are deaf and blind, to at least some extent. There are about 2,000 such people in Scotland. I must tell the Parliament and the minister that the funding for them does not seem to be well co-ordinated. That issue is perhaps not for tonight, but it is one to which we should return.
I thank Cathy Jamieson for raising the subject for debate. I apologise for not signing the motion. When I saw the phrase:
"the introduction of hearing screening on the NHS",
I thought, "My goodness, how many millions of pounds will that cost?" I did not read, as I should have done, the last word of the motion, which said that the introduction of such screening should be "considered". I will sign the motion tomorrow, and I apologise again for not having done so already, but in these times we all find making financial commitments difficult. I very much welcome the debate. I am delighted to have come back from our conference in Perth today to debate an issue that is very worthy of debate.
Listening to Nigel Don, I was reminded of Phil Gallie. In the first session of the Parliament, he used to ask me whether I could hear what people were saying, and I used to reply that I could. It took him quite a long time to realise that he needed to go for a check-up, and he got a hearing aid eventually. I am sure that he will not mind me mentioning his name. The point is that there was quite a long delay before he recognised his need.
With life expectancy increasing, the problem commonly affects people we would consider to be middle-aged and about 10 years from retirement. However, as Cathy Jamieson said, only 6 to 7 per cent of people with difficulties actually wear a hearing aid. My next point was about stigma, but Cathy Jamieson has covered it very well.
There are one or two other points that I do not think have been covered yet. The first came up in a previous debate on the issue. Hearing loss can make people feel more depressed, excluded and isolated, for obvious reasons. As RNID research points out, arguments and incidences of frustration in the home decreased after the person concerned got a hearing aid. I have seen some research that suggests that 70 per cent of deaf people believe that they failed to get a job on the basis of their deafness. Deafness affects their lifestyle and their quality of life.
It has also been noted that deafness can lead to mental health problems. If people feel isolated, excluded and depressed, that is not surprising. I was surprised to read in some research that the average length of stay for a hearing mental health patient in a psychiatric hospital is 148 days; a deaf mental health patient will spend, on average, 19 years in residential care. For so many reasons, investing in services to assist deaf people is definitely investing to help them and to save.
I was surprised to note that the Scottish Government does not know—I might be proved wrong on this—how many deaf children there are in Scotland. Without that information, it must be very difficult to make informed policy and financial decisions about education. Further research confirms that deaf children are underperforming in comparison with their hearing peers, although we have spoken so much lately about "Health for All Children 4", the review of nursing in the community and so on. I ask the minister whether all children have their hearing checked when they start school and during earlier health checks.
I also want to ask about referrals to Donaldson's school. The last time that I visited it, I saw that that wonderful resource is undoubtedly utilised.
I will move to my final point now, as I am getting looks from the Presiding Officer. It is vital that deaf children are given every opportunity to succeed and to become confident individuals and responsible citizens who can make an effective contribution to society. They should not be neglected or stigmatised; they should be given the same opportunities as other children in Scotland.
I am sure that we all find it very comforting that Mary Scanlon should have returned from her party conference to take part in a debate of the quality that she is assured of while in this place.
I thank Cathy Jamieson for raising this important topic. She laid out all the statistical background as to its importance, the problems relating to its being picked up at the appropriate age and some of the other problems that are associated with it, so I shall not rehearse them.
We all have examples from our constituencies of people who find themselves becoming increasingly excluded for some reason, who have social problems and who—as Nigel Don carefully pointed out—have not quite appreciated that it has come about because of a progressive hearing impairment. We have also heard of how, with modern hearing aids, they have lived normal lives—not all of them appear to have tuned into outside radio stations; that was a new disclosure.
While the focus of attention tonight is the RNID hearing matters campaign, for the reasons that Mary Scanlon alluded to I want to start at the age of five, not 55. As Nigel Don said, every child born in Scotland is screened under the universal newborn hearing screening programme. Excellent though that programme is, there are still questions as to our ability to bring together the data so that we are aware of the number of children who are diagnosed as having a hearing impairment and, more important, the extent of their hearing loss and the degree of their impairment. Such data seem still to be falling through the system.
One of the possibly unintended consequences of the universal newborn hearing screening programme is the near abandonment of the early school test. Five might not be the right age to conduct a test, but whereas one is tested immediately after birth, we go through the rest of life without a routine testing programme.
I am not suggesting that we have a separate primary hearing test, but we ought to be considering very carefully what we test and what we do not test as our children enter primary school. As we know, a large number—and a broad range—of learning difficulties, some of which relate to hearing difficulties, are unidentified by primary teachers. There is therefore a case for looking at current problems—whether they are to do with hearing, sight problems or obesity to name but three—in a broader and more systematic way at that early stage.
I agree with Nigel Don that 55 might not be the right age at which to be screened, but the RNID has picked it as a point at which it could make a material change, and I support that. As Cathy Jamieson said, it would ensure that any developing hearing problems were captured much earlier than often happens now, and that would help to remove and destigmatise some hearing problems.
The RNID has stated the case and, even more helpfully—and perhaps unusually—suggested ways in which what it suggests might be delivered. That is very constructive. It points to the possibility of testing being delivered in GP practices—not that that is a substitute for systematic screening, but it would be a good starting point if practice nurses could carry out such tests.
Furthermore, because the minister is always concerned about the cost of such programmes, the RNID has helpfully provided data to show how a screening programme provided through GPs could meet the quality adjusted life years test under the National Institute for Clinical Excellence guidelines. Those are helpful suggestions that I hope the minister will take on board in the positive spirit in which they are offered by the RNID.
I am delighted to have been able to participate in the debate and to support the motion, which asks the minister to give careful consideration to the RNID campaign.
I join other members in congratulating Cathy Jamieson on the motion and the Co-op, of which I am a member, on its choice of the RNID as its charity this year.
The universal newborn hearing screening programme, to which other members have referred, is very important. I have memories—which I was sharing with Cathy Jamieson the other day—of my children being tested by someone rattling keys or some similar object behind their heads, which irritated the hell out of them and did not test both ears.
We have moved on. The fact that we have proper testing is welcome but, as Ross Finnie said, we need to think about the fact that the pre-school testing has been dropped and whether that is the correct thing to do in terms of universal screening. We need to consider whether it should be recognised that there is a possibility of infection occurring and that even the newborn screening test—which is very effective—could miss something. I wonder whether we should take another look at that, perhaps by carrying out a project to study it and find out whether anything has been missed.
I will concentrate on two areas that have not so far been mentioned. One is tinnitus, which affects about 10 per cent of adults and from which I suffer myself. I was trying to work out why I suffer from it. I know that one reason why I have it more intensely in one ear than the other is because I once did some work as a driller in the construction of Loch Awe power station, which is underneath a mountain. I was drilling rock and the noise was such that at the end of a week of shifts it took me the whole weekend to recover my hearing. In those days, before health and safety regulations came in, there were no earplugs and no opportunity to ensure that one was not affected.
Other drillers were drilling the Clyde tunnel at that time, and as they were drilling under pressure they developed even worse hearing problems. I am sure that I suffer from tinnitus partly because of drilling. The second reason I have the problem is because I was assaulted by a very friendly drug-using patient during my brief absence from the Parliament—I feel much safer here than I did in some of the clinics I was running. Assault was not something I enjoyed.
I mention tinnitus because 10 per cent of adults are affected in some way, and half of them are affected to a large degree, so it really begins to trouble them. Around 1 per cent of those people are affected really quite severely. In half of those who are affected by tinnitus, sleep is affected, which can be disturbing for them because they then become more irritable. It is a difficult condition and information is important, but there is not a huge amount that one can do about it.
Ensuring that employees take precautions is very important. My practice worked with United Glass (Closures & Plastics) Limited in Bridge of Allan, where the noise of the machines was enormous. As a result of health and safety legislation, the company introduced noise conduction to take the majority of the noise away, but the employees had to play their part by wearing either earplugs or mufflers. That is an important balance in the regulations for health and safety at work: employees are responsible, along with employers, to try to ensure that people do not subsequently suffer from deafness.
The testing of older patients is also important. In the 1980s, my practice—partly as a result of the work that we were doing with UG—had a machine, which meant that we were able to offer testing to all our patients as part of the screening system that was then in place for older people. We tested people at age 65. The number of people in whom we picked up a hearing problem was extraordinary.
I will finish, Presiding Officer—I know without even looking up that you are looking at me. I will say one final word. One of my colleagues had an old-fashioned hearing aid that people did not like wearing—it was the one with the big battery on the chest. When he did not like what he was hearing in meetings, he would switch it off—and I will now switch off.
I thank Cathy Jamieson for bringing this important matter to the attention of Parliament. It is fair to say, as many members have said, that we all know someone who has been affected by hearing loss. We know how devastating it can be for those who lose their hearing, either through trauma or over a period of time, and the effect that it can have on their life, their family, their work and those around them.
Members will be aware of the national health service audiology modernisation project, which attracted £19 million of central funding, and that all NHS audiology services can now fit digital hearing aids as standard, which is a huge improvement on the previous situation. Following on from that, I was delighted recently to launch formally the national NHS adult audiology rehabilitation quality standards and the paediatric audiology quality standards. The approach taken to developing those standards was unique and has put Scotland at the forefront of quality improvement in audiology. There was a successful collaboration of several cross-border agencies, such as the RNID, the National Deaf Children's Society, the British Academy of Audiology and clinical experts from the NHS in England, Wales and Scotland.
A number of members asked about the newborn hearing screening programme, which is now well embedded in NHS boards. It is critical to a child's development that hearing loss is identified as early as possible and that appropriate steps are taken to ensure that early intervention has the maximum benefit for the child and their family. I welcome the interagency work that takes on board educational and social needs from an early age. NHS audiology departments are in a position to signal early the need for such interagency support.
As we gather evidence, we should keep an open mind about whether there is a requirement to rescreen. I do not think that we have that evidence yet, but of course we must be open-minded about that in future.
I seek clarification on the pre-school check. I read so much about these things. I understood that it includes vision and hearing screening. Did I pick that up wrong?
The newborn hearing screening programme was introduced because of the evidence on when it is best to screen. We should keep under review the issue of whether evidence comes out of the programme over a number of years that there is a requirement to rescreen later, in the light of things being missed during newborn screening. However, at the moment, we really do not have the evidence for that.
Both sets of standards and their associated quality rating tools have been well received by service providers and are seen as making a critical contribution to quality improvement. The on-going process of self-assessment and peer review of the standards will enrich the sharing of best practice and highlight the need for improvement in areas that are found not to meet the standards. As a result, the process will improve the standards of care to patients and ensure the important principle of equity of service throughout Scotland.
Delia Henry, the director of RNID Scotland, also served on the standards group and attended the public meetings. I welcome her involvement and the co-operation with the voluntary sector in general. We are all working to the same end—to achieve the best outcome for patients. By working together, we are more likely to achieve that. Delia Henry also sits on the audiology services advisory group, which represents a variety of stakeholders and advises me directly on matters relating to the provision of NHS audiology services.
As Cathy Jamieson said, in 2006, RNID Scotland approached the Scottish Executive to assist with funding the hear to help project in Galashiels. That important project has provided a point of contact for people who are deaf or have hearing difficulties. It provides a place where people can receive at first hand information, guidance and support. Since 2007, the Scottish Government has funded that project, with £40,000 per annum until 2010. So far, we have had excellent feedback on the level of service and the information that is available.
Our commitment as a Government goes beyond the support that is required by those who are deaf or have a hearing problem. We are also committed to improving services for anyone who has a sensory impairment, be it hearing loss, vision loss or deafblindness. I will look into the issues that Nigel Don raised with respect to deafblindness in particular. With that in mind, the Government will look to support more innovative ways to ensure that appropriate services and information are provided and delivered. As I said earlier, we will do that by working in partnership with groups, such as RNID Scotland, that represent people with a sensory impairment.
The gradual loss of our hearing affects most of us at some stage in our lives—some of us earlier than others—and once we are being cared for by NHS audiology colleagues, the care continues for the remainder of our life. It is therefore important that we give everyone who comes to us the best quality service that we can, and that we support rehabilitation, where possible, to enable a better quality of life.
As Cathy Jamieson said, the First Minister announced in September 2007 that audiology services would, for the first time, be brought within the 18-week referral-to-treatment target. I am confident that all NHS boards will meet that target for adult services by 2011. Although the information and statistics division is still to confirm this, we hope to have the figures that Cathy Jamieson asked for by August. I will keep Parliament updated on that.
I am of course aware of RNID's hearing matters campaign; indeed, I attended the parliamentary reception last week to launch deaf awareness week. I agree whole-heartedly that hearing does matter, and I assure members that I take a keen interest in issues affecting those with hearing loss.
As a Government, we need to ensure that all resources are used effectively and that any screening programme that we introduce is both clinically effective and cost effective. We receive advice on population-based screening programmes from the UK National Screening Committee. This Government and previous Administrations have followed that committee's advice. Its advice on screening for adult hearing loss is that, at present, it should not be offered. The NSC has assessed an adult screening programme against its criteria, to determine whether such a programme would be both clinically effective and cost effective. At the moment, there is not enough evidence to recommend it. That was also the finding of a report from the National Institute for Health Research in 2007.
The policy was reviewed as recently as March 2009, but no significant changes were made. It is due to be reviewed again in 2011-12, and that review will take into account findings from any new research. Our officials continue to monitor the findings of the National Screening Committee on my behalf. We will keep the situation under review.
Are those research findings based on a pilot study for a screening programme for over-55s? Has such a programme been run in Scotland?
No, not in Scotland. The research on which the National Screening Committee based its recommendations is broad and comes from a variety of sources. I can supply Mary Scanlon with more specific information on that.
It is encouraging to note from the RNID survey that there is so much support within Parliament to ensure that hearing loss is identified at an early stage. That underpins our commitment, and I believe that our actions will achieve the aim. We are working with audiology services and the primary care sector to ensure that GPs are advised on triage to identify potential hearing loss and to refer people to NHS audiology experts. I believe that it is better to work in that way, to ensure that people—no matter how old they are—can have their hearing loss identified. I believe that our plans will deliver that.
I commend the work that voluntary agencies do to raise awareness of issues affecting those with hearing loss, and I commend the commitment displayed by people in NHS audiology services who support patients from referral through to the fitting of hearing aids and their further rehabilitation. I am aware that there is still work to do to ensure equity of service across Scotland, but the standards that I have referred to will go a long way towards addressing that.
I am confident that the modernisation of NHS audiology services continues apace and that patients are benefiting from improved services. Scotland is leading the way in quality standards for all. The whole chamber will be proud of that.
Meeting closed at 17:39.