The final item of business is a members’ business debate on motion S6M-16452, in the name of Sharon Dowey, on improving access to hearing care for Scotland’s ageing population. The debate will be concluded without any question being put.
Motion debated,
That the Parliament understands that over 900,000 adults in Scotland live with age-related hearing loss; believes that uncorrected hearing loss can have a significant impact on people, notably social isolation, mental ill health and a heightened risk of developing dementia; understands that demand for hearing care services is increasing across the country, including in Ayrshire, as a result of changing demographics; notes that the number of over 60s in Scotland is projected to increase by 50% by 2033, and that South Ayrshire is the fastest ageing local authority area; notes the view that additional capacity in NHS services is needed to ensure that people presenting with hearing loss can access quality and timely care; considers that independent providers of audiology services have the skills, IT connectivity and capacity to meet the increased demand; notes the Scottish Government’s commitment to bolster community audiology provision and put community audiology services on a par with the country’s free community eye care services, and further notes the view that there is an opportunity to improve dramatically access to hearing care services by replicating this model.
17:28
I am delighted to bring this vital topic to the chamber for a members’ business debate. I thank colleagues from across the chamber for supporting the motion, and I look forward to hearing their contributions.
In the Scottish Parliament, we often debate Scotland’s ageing population and the various ramifications of that for health services, communities, families and quality of life. Of course, the fact that people are living longer is a good thing, and it should be celebrated—nothing could be better than being able to spend more years with our loved ones. However, as parliamentarians, we cannot afford to ignore the challenges that it presents, too.
Like almost all western countries, Scotland has a declining birth rate and, on top of that, the number of those who are aged over 60 is projected to increase by 50 per cent by 2033. That is especially true for the area that I live in and represent. South Ayrshire is the fastest-ageing local authority area in Scotland, and, by 2043, one fifth of its population will be over the age of 75. I will speak later about the significant impact that that is having on the local population and on providers.
We have heard many times about the various pressures that that will place on the healthcare system, including the number of staff who are needed and the resources that are required. We have also heard about the imbalance that exists, with a smaller working-age population paying taxes to support an increasing number of people who have served their time at the coalface and now deserve to enjoy retirement knowing that there is a stable and reliable healthcare system behind them.
Today, I will talk specifically about audiology services. As my motion states, it is estimated that more than 900,000 people in Scotland are living with age-related hearing loss. As a result of that increasing number, services across the country appear to be struggling to keep up. I appreciate that the Scottish Government has identified that area as a key priority for improvement, and I hope that today’s debate will go some way towards helping with that improvement.
We know from research that waiting times for various audiology appointments are too long, and some people can be left for several months without getting the help that they need. We know that, as with almost every other service in the national health service, provision is under so much strain, and hard-working staff are struggling to keep up with an ever-growing workload.
However, there is more to it than that. Hearing loss is different from many other ailments that are frequently debated in the chamber. It can be hard for an elderly person to come to terms with the fact that their hearing is worsening. It can often be years before someone can be persuaded to seek help, and, by that point, significant damage will have been done. Social isolation, depression and loneliness are all exacerbated by hearing loss and, worst of all, it has been identified as the single largest avoidable risk factor for dementia.
Therefore, improving services must also take account of what we can do to encourage elderly people and their families to step forward, and, when they do, we must ensure that the NHS is ready for them, and not just at the first appointment. The aftercare system is equally crucial, especially as research suggests that people can abandon things such as hearing aids if they do not get comfortable with them quickly. We also need to ensure that services such as those that provide maintenance and battery replacements for hearing aids are up to scratch, especially in rural areas.
A number of private providers step up, too, such as Specsavers, and we should not be afraid to listen to those organisations when it comes to creating the very best services. Last year, I met members of the Specsavers team in Ayr to learn about the work that they are doing to support people with hearing difficulties. Thomas Allison, the audiology director, and Linda Fulton, the retail director, spoke at length about the challenges that people in the area face. They are aware of the demographic challenges in NHS Ayrshire and Arran, where they estimate that nearly a quarter of the population have some form of hearing loss.
About 4,000 adults in the health board area are waiting for their first appointment for hearing issues, and the average waiting time is anywhere between 18 months and two years. Specsavers staff in Ayr hear horror stories every day from locals, many of whom have come to Specsavers because they have given up on the NHS.
I also heard about how things are different in England, where an any qualified person scheme is in operation. That means that some of the care that is usually provided in hospitals can be provided on the high street as long as those who are providing it are qualified. Given that Specsavers has a proven infrastructure for providing such services elsewhere in the United Kingdom, it would surely be of use to Scotland, including Ayrshire, too. The team told me about the importance of creating a positive environment for people to come in for follow-up care and about how many returning customers enjoyed chatting with the staff while getting their hearing aids cleaned.
Working alongside our NHS, companies such as Specsavers can contribute to building an audiology landscape that is ready for the demographic evolution that we face. I know that there have, in the past, been tensions between official audiology services and what is offered on the high street, and we must all work together to ensure that those two strands work with each other, rather than in opposition. We might even get to the point at which more patients could have their hearing loss managed in the community, which would take the pressure off hospitals and could even save money.
The Scottish Government has, in the past, stated that it would like audiology care to be on a par with what is offered in eye care services, and I fully agree with that aspiration. We do not always find consensus in the chamber, but I hope that, on this issue, we can come up with a plan to help the hundreds of thousands of elderly people struggling with their hearing who need exactly that.
As I mentioned, there are professionals in Ayr who deal with this kind of thing every day. They know better than anyone the challenges that we face, but they have some solutions, too, and MSPs would benefit very much from listening to them.
I finish by mentioning something that a doctor told me last week. We had actually met to discuss women’s healthcare, and she had great ideas about how to improve the service that we currently give, but she said one thing that could apply to all areas, which is that we can choose to deliver the service differently. That is what we need to do.
17:35
I congratulate Sharon Dowey on securing this debate. As the Parliament’s only—perhaps last—octogenarian MSP, I should perhaps declare an interest, because people of my age certainly become aware that their hearing is not in as sharp shape as it was in their youth. It is a realisation, rather like needing glasses, that sneaks up on people. I had compensated for my short-sightedness by recognising people by their gait and the sound of their footfall. I can still do that. I did not realise until I could not read a notice board in a lecture room that there was more to it. Glasses, and now contact lenses, are a liberation.
Hearing loss follows a similar path. I began to notice that I preferred to sit in the middle of a group, because then I could more clearly hear the conversations. Ambient noise disrupts people’s hearing. Their whisper—my colleagues will identify with this—becomes more of a stage whisper. People say “Pardon?” or “Sorry?” far too often. The difference is that people do not find a reduction in someone’s vision funny, but hearing loss can certainly make someone the butt of a joke. It is time that that stopped. Loss of hearing—small or large—can have an impact on our wellbeing. We might keep apologising when we have absolutely nothing to apologise for.
At this point, I will slip in a point about the importance of earwax removal by a professional. Earwax might not be the sole source of reduced hearing, but it certainly does not help. However, not all general practitioners now provide that service and, at about £60 for private treatment, it is not an option for everyone.
As more of us, thankfully, grow older in Scotland, it is no surprise to find that, currently, just under a million adults have their hearing affected, and demand for services is expected to rise significantly as the population ages. Indeed, the number of over-60s is projected to increase by 50 per cent by 2033—I do not think that I will be around then.
However, all is not lost. Midlothian Council has developed a strong partnership with Deaf Action to support residents of all ages who are living with deafness or hearing impairment, through initiatives such as—this is just one example—outreach and home support, covering health, financial and social issues. Similarly, in the Scottish Borders, the Royal National Institute for Deaf People’s Near You service is a community-led success. In 2024, it supported 2,497 people through local drop-ins and phone and online support. It also engaged in more than 4,300 individual interventions, including 1,907 hearing aid support interventions, 2,347 information and advice sessions and 116 hearing checks.
However, as is the case everywhere, Midlothian and the Scottish Borders face funding pressures, and—for reasons that we all appreciate and I need not expand on—accessing services in rural areas is more expensive. Therefore, bringing audiology services into community settings, on a par with Scotland’s eye care model, would be most welcome. That early intervention could prevent more serious ear conditions from developing and help to tackle preventable mental health problems, cognitive decline and isolation, which can be linked directly to hearing loss. Frankly, and quite brutally, it would help the public purse. This is a well-worn mantra, but it is worth saying again: spend to save. I would like the Government to provide the same kind of access to audiology services that we have to free eye care and eye tests.
17:39
First, I congratulate my friend and colleague Sharon Dowey on securing the debate. This is an important issue, which is not spoken about enough. It is disappointing that many of the fundamental issues that affect people in Scotland are addressed only in members’ business debates, without the full focus of the Government and at a time when many MSPs have other commitments. That is not to say that the minister will not listen to the debate intently—I am sure that she will—and I sincerely hope that progress is made on the issue.
I want to highlight the issue of hearing loss and dementia. We know that Scotland has an ageing population, and we know that health and social care demands increase exponentially as we get older. Although dementia is not classed as an elderly person’s disease, it primarily affects people over 65, with 96 per cent of cases in Scotland involving people over that age.
What concerns me most about the issue is that, although we know that there are direct links between sensory loss and dementia, we do not routinely test for sight or hearing issues when we diagnose a person. How can we be sure that any treatment plan will work for the patient if we do not know how much they can see or hear?
After this debate, I will attend a meeting of the cross-party group on deafness, on which I work with some fantastic people on the issues surrounding deafness and deafblindness in Scotland. The group has been working on a report that highlights the problems in the current diagnosis pathway, which cannot help but have a knock-on effect on treatment. The results of the surveys that were conducted for the report showed that only 6 per cent of GPs and 12 per cent of other health and medical professionals would assess both sight and hearing as part of an integrated assessment of memory or dementia. That is a big problem, as most dementia assessments rely on the person being able to see or hear the questions. We are diagnosing somebody with dementia without considering whether they have any sensory impairment. Dr Hannah Tweed from the Health and Social Care Alliance Scotland says:
“Brain changes caused by dementia can have similar symptoms to Deafness, Deafblindness or Visual Impairment—and many people experience both dementia and sensory impairment. But even when standard dementia assessments are done, the results aren’t able to separate dementia brain changes from sensory impairments which commonly overlap.”
We must, therefore, ask how we know whether we are actually diagnosing dementia.
The ALLIANCE is calling for sensory assessments to be a mandatory part of dementia assessment, and, considering that the number of dementia cases is set to rise by 50 per cent in the next 20 years, it is prudent to ensure not only that we are diagnosing the issue correctly but that we have in place adequate treatment plans for people, which is also essential.
A lack of proper sight or hearing assessments, or even clear guidance on who is responsible for that assessment, can lead to poor and inadequate care or, at worst, people’s sensory impairments being continually missed.
I know that work has started with Healthcare Improvement Scotland on Scottish intercollegiate guidelines network—SIGN—guidance on next steps that can be taken to implement some of the dementia report recommendations. I urge the Scottish Government to work with the ALLIANCE and HIS to make that happen.
I look forward to a time in Scotland when sensory assessment is just a matter of routine, with everyone having access to improved care pathways and with support for people who not only have dementia but experience deafness, deafblindness and visual impairment.
17:43
I thank Sharon Dowey for bringing this debate to the chamber. It concerns an area that I have recently discussed with constituents, audiologists and third sector groups that support older people in my region.
As we have heard, hearing loss is very common. In fact, it is one of the most common disabilities in the UK. In 2015, Action on Hearing Loss Scotland estimated that there were 945,000 people living with hearing loss in Scotland, which is one in six of the population. As we have heard, the statistics speak for themselves.
The issue affects many people and their families. More than half the population over the age of 55 has some form of hearing loss, and the presence of hearing loss rises with age. It is estimated that 70 per cent of people over the age of 70 have some degree of hearing loss. Given the demographic changes in our population, the prevalence of hearing loss is set to continue, as we have heard from other members. It is, therefore, right that Sharon Dowey is raising the issue tonight and giving us an opportunity to discuss options for future service delivery.
Of course, it is real stories that shine a light on the issues that we discuss. Going through the literature that was provided for us by the Scottish Parliament information centre during my research for the debate, I was particularly struck by some of the words from Kathryn, a retired nurse. She said:
“The best thing for me is feeling whole again ... My hearing loss happened gradually. I didn’t suddenly realise it was a problem. I was continually asking my husband to turn the television up and would often take a back seat in social situations.”
I think that many of us know that social isolation can be so hard for people. I particularly liked how Kathryn described the way that she felt after she got her hearing aids. She said:
“It was incredible the first time I listened with them ... The immediate impact of being able to hear again was realising how much I had missed—like the joyful sound of birds singing. I believe it lifted my mood and I think it increased my confidence.”
Improved hearing is really important for people. Kathryn said that she could appreciate music again, hear children, and experience all the things that lift our spirits and make us feel positive. It has a real impact. One thing that I had not considered was what she said about feeling safer because she could hear cars coming and things like that. She also said that she wears her hearing aids with pride, which is an important point.
I also want to mention the impact on families. We know from RNID research that nine out of 10 of us would feel upset if a family member was missing out on a conversation or avoiding having a conversation altogether because of hearing loss. However, one in three say that a family member regularly does not hear them or asks them to repeat themselves. Despite that, many of us struggle to know the right way to speak with people about the issue.
I agree, because that is my own experience. Everyone else in the household and the wider family is talking about how bad things are or how frustrated they are by a member of the family not hearing them, but they rarely mention it to the individual who is suffering from hearing loss. It is so important that we discuss these matters and encourage people to talk freely about what is happening to them or their loved ones and about what can be done.
That brings me to the point that we are here to discuss tonight. There is no doubt that, in Scotland, we must galvanise ourselves to implement NHS community audiology services to ensure access to them, as they are incredibly important. We know that waiting lists are long in hospital settings, but there are opportunities, and many people want to have those opportunities within the community.
In response to a question that my colleague Jackie Baillie recently asked, the Government said:
“Audiology is considered as a clinical priority area and the Scottish Government remains committed to its vision for an integrated and community-based hearing service in Scotland.”
It also said that it wants to
“continue to work with the NHS, Third Sector and private providers to identify and cost an appropriate model of community care for any future service reform”.—[Written Answers, 10 March 2025; S6W-35353.]
In closing, I say to the minister that I am interested to hear what the options are, because we need to make sure that there are options. I would not like us just to go down a road of using private services, so it would be good to know whether the Government has managed to get that work done. Given the time, I will close there.
17:48
I congratulate my colleague Sharon Dowey on securing the debate, although I feel that it is a debate that we should not be having. We should not be in the situation that we are in now.
The system that we have in place is cruel. Audiology is in crisis. Imagine saying to an elderly person, “I’m sorry, but we’re not going to be able to see you for two years.” We in the chamber can all recognise how inhumane that would be, but the waiting times in NHS Grampian, for example, show that people are having to wait for two years before they get an assessment and then wait longer to get a hearing aid.
As Christine Grahame points out, all that leads to social isolation and links to dementia. There is also an impact on family and community settings. I imagine that people can only say “Pardon?” once or twice before they withdraw from engaging in conversation altogether. The issue should be looked at as soon as possible.
The answer is clear and has been accepted by all: we need to get people out of a hospital setting. Ninety-four per cent of people with hearing loss have uncomplicated adult-onset hearing loss that is suitable for community treatment. At present, those patients compete for the limited capacity that is available to treat children and adults with sudden onset hearing loss and specified comorbidities, who have to be treated in hospital.
There is absolutely a need for intensive audiology in major hospital settings, but the specialists involved should be reserved for the 6 per cent of cases that involve traumatic hearing loss or child hearing loss from birth. However, just now, so much of that resource is being spent on people who should be not in a hospital setting but in community settings instead.
As Sharon Dowey pointed out, we already have a solution in our communities. Companies such as Specsavers, which I visited on Friday—I even had a hearing test done—already provide that service. As we have said, we already do community eye care so, surely, we should just replicate that for hearing.
A couple of months back, I met Neil Gray and Jenni Minto, and the issue was one thing that I spoke to them about, because I had raised questions on it. I thank them for that time.
NHS Grampian would be an ideal place for a pilot on community audiology. There are huge waiting times and a real need for something to be done. I urge the Government to take on the seriousness and urgency of the issue and move with pace, because we are talking about mainly elderly people who might be reaching the end of their lives. We need to look after them and make sure that they can communicate with everyone else as much as possible.
17:51
I, too, thank Sharon Dowey for lodging the motion. I welcome the opportunity to conclude the debate. I also thank everybody for the tone of their contributions—clearly, the topic is something on which we all agree.
I note Roz McCall’s comments about the connections between sight and hearing loss and dementia. Although dementia does not sit in my portfolio, I know that Maree Todd will be very interested in the conversations and the points that were raised.
From personal experience, I recognise the importance of supporting people who live with dementia with their hearing so that they avoid loneliness, as many have commented. I reiterate the Scottish Government’s commitment to improvements in the way that audiology services are delivered. The publication of the report “Independent Review of Audiology Services in Scotland” highlighted real failings in the way that care was delivered in Scotland, but it also recognised opportunities to build on the services to give real improvements to those who use them.
As Sharon Dowey and others have pointed out, the number of adults in Scotland with age-related hearing loss is growing. Almost one in six of the population experiences some form of hearing loss. It is right that we should provide those patients with a clinical service that meets their needs—not only to diagnose their condition quickly and efficiently but to manage that condition and lessen the impacts of social isolation and loneliness. I, too, will attend the cross-party group meeting tonight.
I was struck by Christine Grahame’s comments on stigma and the differences in the way that we treat sight and hearing. I will take that away for when I speak to my officials again; I had a conversation with them this afternoon about the Scottish Government’s work on audiology more widely.
That point is one of the reasons why many people disguise the fact that they cannot hear what is going on, which makes it worse for them. They suppress it, because they know that it will be an amusement to many people.
Christine Grahame has raised an important point. While she was speaking, I was thinking about the difference. My father wore glasses from a very young age and could only have the NHS-style ones; now, however, there are so many different styles that people can get. There is possibly the same stigma about the size of hearing aids, as opposed to the much smaller ones that are currently available. That was a really important point, which was well made.
As with many of our clinical services, waiting times are increasing, and patients cannot access them as quickly as we would like. However, the 2025-26 budget provides record funding of £21 billion for health and social care, and health boards are receiving an additional £200 million to reduce waiting lists and support the reduction of delayed discharges. I hope that that funding will be a welcome addition to health boards, and it should build on the work that they have already been doing to address waiting times by reducing their failed-to-attend rates through patient-focused bookings.
References have also been made to the Scottish National Party manifesto commitment to bolster community audiology provision to help to free up capacity in our acute sector. The Scottish Government remains committed to that vision. We are all familiar with the manifold benefits that increasing community provision brings, both in reducing the cost of services and in supporting patients to receive care when they need it, without the constraints of waiting times, as members have referenced with regard to optician services.
It is good to hear that the Government is still committed to community audiology. Can the minister give a timescale for when that change will start to happen?
Getting access to the service initially is only one issue; the follow-up is also missing. I speak to many people who have NHS hearing aids, but they never go back to get them checked. That is something else that we are missing out on.
I can give you the time back for that, minister.
I will touch on Mr Lumsden’s second point later in my speech. I am afraid that I cannot give timelines, but that conversation started earlier today with regard to moving on audiology in the community.
The Scottish Government has a strong desire to deliver care as close to the patient as possible. That is an example of where our population-based planning principles will provide benefits to patients and staff.
As I highlighted, we have been working specifically on the “Independent Review of Audiology Services in Scotland” report. That is part of the work that we are doing to ensure that we have the right evidence base so that we deliver value for money and ensure sustainability in the longer term. The commitment is evident through our on-going work with the Royal National Institute for Deaf People to deliver the Near You service, which is supported by nearly £250,000 of funding. Christine Grahame mentioned the service in NHS Borders. I had the privilege of seeing the work at first hand during a visit to Portobello library in the NHS Lothian area in February.
As Christine Grahame noted, Near You offers free hearing checks, hearing aid services and aftercare, as well as information and peer support on matters such as hearing aid maintenance and assistive technology for those who are deaf and are experiencing hearing loss or tinnitus. The feedback from users has been extremely positive, with regard to both decreasing the pressures on our acute services and providing direct support to those who are affected.
In response to Mr Lumsden, I say that that is one of the key things that we must remember. As I say in a lot of meetings, it is about the third sector, health boards and the Government working together to make those connections. I heard from users of the Near You service and the RNID, which provides that service, about the importance of the relationship. The RNID felt that it could take people away from the front door of hospitals to allow hospitals to treat those with more acuity. I agree with Mr Lumsden that we must make sure that there is aftercare, but we need to check where that aftercare is best placed.
Ms Dowey and others noted that independent audiology providers have the skills, information technology connectivity and capacity to support our audiology services. I do not disagree that independent audiology providers are giving a great level of care to those who use them. However, the NHS continues to be the majority care provider for the people of Scotland, accounting for around 80 per cent of all audiology care.
We must also recognise that, due to shared pipelines, independent providers face similar workforce challenges to the NHS. We are working to address the shortfall in the number of trained audiology graduates through our commitment to develop a career pathway for those studying healthcare sciences. We are working with stakeholders across Scotland to ensure that that will provide a pipeline of staff to bolster audiology services.
Overcoming those workforce challenges will not happen overnight, and it will take time to support students in our workforce. During that time, it is therefore vital that we work together to ensure that the people of Scotland receive the care that they need to manage their conditions. I commit to keeping open any lines of communication with representatives of independent providers, and I will invite their input when discussions on the development of a community model for audiology progress.
I agree that there is much to do and that it is vital that we get this right for the people of Scotland. I am confident that we in Government are already taking the right steps to deliver sustainable, safe, effective and efficient services to support hearing loss for our population in the longer term, and the matter has my full focus.
Thank you, minister. That concludes the debate.
Meeting closed at 18:00.Previous
Decision Time