Audiology Services
The members' business debate is on motion S1M-2436, in the name of Mike Rumbles, on digital hearing aids and a review of audiology services.
Motion debated,
That the Parliament notes that the Scottish Executive is conducting an audiology services review; recognises that many hard of hearing and profoundly deaf people are still provided with out-dated analogue hearing aids; is aware that new digital hearing aids can improve the quality of life for those who need them; realises that digital hearing aids are not widely available on the NHS in Scotland and are expensive to purchase privately; understands that the cost can be dramatically reduced by a system of bulk-buying; further notes that such a scheme has been introduced into 20 NHS hospitals in England, and considers that the Scottish Executive should make a commitment to provide digital hearing aids on the NHS in Scotland.
I thank the members of the Parliamentary Bureau for accepting my motion for debate. The issue is important to many people throughout Scotland. I take the opportunity to congratulate Mary Mulligan on her new appointment.
The background to the debate is that, some 18 months ago, I highlighted the problems faced by my constituents in West Aberdeenshire and Kincardine in obtaining digital hearing aids. Last year, the then Minister for Health and Community Care informed me that the aids were indeed available on the national health service. I soon found out that Grampian University Hospitals NHS Trust was unfortunately unable to fund them.
I asked the minister a parliamentary question about when the Scottish Executive expected digital hearing aids to be made available through the NHS in Grampian. The then Deputy Minister for Health and Community Care replied that the decision was for the health board. He said that the decision had to be taken locally, based on local priorities. He informed me that nine different types of digital hearing aids were available in Scotland through the health service. He invited me to submit any information that I had to his officials, who were at that time carrying out a survey of health boards and trusts to assess the situation.
Since then, I have continued to pursue the issue with ministers by lodging questions. On 1 November, I asked the then Deputy Minister for Health and Community Care—I see that Malcolm Chisholm is in the chamber—to give the same assurance that has been given to patients in England and Wales, who have received a pledge that they will have access to digital hearing aids within the next three years. I believe that the same pledge will soon be given to patients in Northern Ireland.
I call on the Scottish Executive to implement the bulk-buying scheme that, in England, has cut the cost of digital hearing aids to the health service from about £2,500 to about £250. In answer to another written question on 9 November, the Scottish Executive confirmed the good news that the aids are now available through the national health service at prices ranging from £120 to £535, which is way below their private cost.
However helpful the minister is today, it is not satisfactory to know that, although the aids are available throughout Scotland, funding decisions by health boards must be made locally. That simply means that the aids are not available to those who need them.
I recently met Lilian Lawson, the director of the Scottish Council on Deafness. I believe that she is in the public gallery today, together with representatives of the Royal National Institute for Deaf People and several other groups with an interest in the issue. Lilian's organisation contacted every health board to ascertain the situation following Malcolm Chisholm's welcome £10 million boost to the NHS for community care earlier this year. The responses were less than encouraging. The worst was the response of Lothian Health, which said:
"No funding was invested specifically in hearing aids … colleagues did not identify this as a priority need."
Grampian Health Board did not even reply, although in its defence I should say that the chief executive assured me on Monday that the board had not received the letter. The best response came from Highland Health Board, which confirmed that £100,000 was allocated for the purchase of digital hearing aids. However, the response from throughout Scotland has been completely inadequate and local health boards cannot be allowed to get away with that.
There is no doubt in my mind that audiology services throughout Scotland are neglected. The RNID survey shows that more than 400,000 people could benefit from hearing aids, while only 170,000 have them. One third of hearing aids are never or rarely used. There is an acute shortage of trained audiologists and inadequate funding to recruit and train more. Not everyone can benefit from, or even wants, a digital hearing aid, but the number of people who have contacted me to tell me the real difference that digital technology can make is astounding.
I want to focus now on waste. Yes, I said waste. I have just said that one third of hearing aids are rarely or never used. The Audit Commission, in its report of March last year, said that that happens
"because of the poor quality of aids and the advice given. This is due to a combination of poor technology, rushed fittings, patchy fitting skills and inadequate guidance and support for hearing aid users. This represents a waste of money, as well as excluding deaf or hard-of-hearing people from society."
This is a big social exclusion issue. I am sure that the minister will agree with the findings of the Audit Commission. However, it is not sufficient just to agree with the sentiments; we need action. Mary Mulligan and Malcolm Chisholm, that is where you come in. I acknowledge that the Scottish Executive is conducting an audiology services review, but it is not due to report for another 12 months. The ministers will surely agree that we cannot fall behind England, Wales and, as I hinted earlier, Northern Ireland.
It is not enough to say that local health boards must decide on their priorities. I acknowledge that there is great pressure on the health budget and that the minister may not be in a position to provide more funds for audiology services nationally, but I note the UK Government's intention to increase health spending, as announced yesterday by the Prime Minister. That will have consequences. All I ask is that, when the minister responds at the end of the debate, she will do what she can to address my points.
Of course I would like her to commit new funding, especially after the Prime Minister's announcement. However, if nothing else, I call for her to take action to highlight the importance of audiology services to the deaf and hard of hearing, and to make the importance of the issue clear to health boards, asking them specifically to reassess their priorities and take effective action. If we have a truly national health service, we cannot simply leave it to local decisions as to when, if ever, health boards go digital.
There are a great many people waiting for the minister to respond. I hope that Mary Mulligan will respond positively and that she will ask the health boards to take the action that is needed.
I cannot extend tonight's debate, so I ask members to try to keep their speeches to three minutes.
I congratulate Mike Rumbles on securing tonight's debate. As members will know, I convene the Scottish Parliament cross-party group on deafness. That group was launched following a successful members' debate last year. So many members were present at that debate that we agreed that it was an issue that we would be interested in pursuing. Since then, I am pleased to report that the group has made good progress on many fronts in promoting the interests of deaf, deafened and hard-of-hearing people in Scotland.
I welcome the RNID's commitment to highlighting the issue of digital hearing aids; I have received several postcards from constituents. I wrote to Malcolm Chisholm on their behalf and was encouraged by his response.
The situation is not as black and white as it may seem. I understand that digital hearing aids offer help to those with mild or moderate hearing loss—they often work best for those who have a newly acquired light or moderate hearing loss. They do not suit all deaf or hard-of-hearing people and I have been told that many have felt let down by the hype. However, according to two of Scotland's leading audiologists, in 85 per cent of cases, digital aids are superior to current practices.
I understand that in Scotland there are more than 150 different models of hearing aid listed on Scottish contracts. Of those, there is a choice of 11 NHS digital aids, which are available at all sites throughout Scotland. In England, only 20 sites have a choice of only two NHS digital hearing aids. I understand that digital aids will not be generally available in England until 2002. I do not believe that we can say that all is good in England and that all is bad in Scotland.
If a deaf or hard-of-hearing person would benefit, a digital hearing aid should be available to them. However, it is clear that digital hearing aids are not the only clinical solution, nor always the most effective one. However, I am concerned that not all those who could benefit from one have access to a digital hearing aid. There is a mechanism to achieve that—through the good practice guidelines—but it is not clear that the resources are there to back that up.
I wrote to the chief executives of Greater Glasgow Health Board and Lanarkshire Health Board—those are the boards that cover my constituency—for information on the use of digital and analogue hearing aids in their areas. According to Greater Glasgow Health Board, it simply does not have the resources to implement the best practice guidance. The cost of implementing that guidance is estimated to be between £1.5 million and £2.5 million in the Glasgow area. That must be addressed.
I welcome the setting up of the audiology review working group and the work of securing an extension of the group's sub-group—the audiology needs assessment group. I am pleased that that now includes a member of the RNID, who is also a member of the cross-party group on deafness and is a deaf hearing aid user.
Last night, at the cross-party group's annual general meeting, we received a report on the work of the audiology review working group. The scope of the review has been increased, which is a welcome development. Mike Rumbles mentioned the different work that is being done across Scotland and in the various health board areas. He mentioned Lothian Health as a health board that has a lot of catching up to do. However, last night, the work at St John's hospital in Livingston was brought to our attention. A sensory impairment centre was recently opened at the hospital. Members of the cross-party group highlighted the good practice of that department. I would like to see the good practice of St John's hospital rolled out across Scotland. The guidance from the Executive is well-intentioned, but firmer guidance must be given to local health boards to implement a policy that will improve audiology services for all deaf and hard-of-hearing people throughout Scotland.
I welcome the new minister, Mary Mulligan, and hope that she soon settles into her new role.
I congratulate Mike Rumbles on securing the debate, and the RNID on its excellent work to highlight the situation with regard to digital hearing aids. As Mike Rumbles said, a great many people are waiting for a response from the Government. I hope that we get it.
The issue is quality of life. Like many members here this evening, the issue was brought to my attention by numerous letters and cards that I received from constituents. On their behalf, I wrote to Malcolm Chisholm highlighting the concern that, of the 170,000 hearing aid users in Scotland, only 0.6 per cent have access to free digital hearing aids on the NHS.
According to the RNID, most NHS hearing aids are based on technology that is 20 or 30 years out of date. In its report entitled "Fully Equipped" the Audit Commission went into more detail. It is worth quoting its findings:
"Reports suggest that a third of"—
analogue—
"hearing aids are infrequently or never used because of the poor quality of aids and the advice given. This is due to a combination of poor technology, rushed fittings, patchy fitting skills and inadequate guidance and support for hearing aid users."
All that can be dealt with if there is the will to do it and the resources are provided. The report continues:
"This represents a waste of money, as well as excluding deaf or hard-of-hearing people from society."
That is at the heart of the debate. The report further states that digital hearing aids
"deliver superior performance, particularly in eliminating background noise … and can be programmed to meet individuals' specific needs … Clinical trials have found that users with digital aids increase their use of the aid (from an average of 6 hours per day to 11 hours per day)".
Those are useful outcomes, and we should aim to assist them.
As has been said, in England the Government is taking direct action to address the issue. Already, 13,270 digital hearing aids have been fitted as part of its pilot project. Preliminary evaluation results look good with respect to hearing aid use and benefit compared with analogue aids. The difference that is made to people's lives cannot be overstated. The new digital technology allows people to live fuller and more independent lives.
In response to my letter, Malcolm Chisholm stated:
"digital instruments may not offer a significant improvement for all patients and as you will appreciate, each individual case must be a matter for the clinical judgement of the clinicians concerned."
Indeed, minister, digital hearing aids may not benefit all patients, but it is clear from the evidence of the RNID, the Audit Commission and those who currently are benefiting from digital hearing aids that digital hearing aids offer a significant improvement on the present situation.
The minister further stated:
"digital hearing aids would be supplied whenever clinical judgement indicates that they would provide benefit to the patient involved that would not be provided by other types of hearing aids."
If that were the case, undoubtedly more than 0.6 per cent of the 170,000 hearing aid users in Scotland would be making use of free digital hearing aids on the NHS.
For a relatively small price, the Government could improve the quality of life of a large number of Scots. It is time for the Executive to act and to give a firm commitment to digital hearing aids for all who require them in the NHS system. That is the sort of commitment that I want to hear from the minister at the end of the debate. I certainly hope that we will hear it.
I repeat my warning that speeches should be closer to three minutes, please.
I apologise to Mike Rumbles, because after I deliver my speech I will have to leave the chamber because I have a doctors appointment at 6—we know how long we have to wait nowadays for one of those.
I congratulate Mike Rumbles on bringing the subject to the chamber today. Coincidentally, about a month ago I had a letter from a constituent in the Bridge of Don. He was an ex-Scots Guard, and wrote to me and to his constituency MSP on the subject. He served with the Army for 30 years and then with the police in Aberdeen. His hearing has deteriorated recently, and he wrote to say that it had been recommended to him that he should get a digital hearing aid, but that it would cost him £1,500. However, such a hearing aid would cost less where his daughter lives in England, under one of the schemes there. He asked me questions that I ask the minister to answer: how can that be? Is that right?
The problems that are associated with digital hearing aids are nothing new. They are part of the problem of postcode prescribing, on which I would like to expand. Postcode prescribing has worsened in the past four years. Hearing aids join the list of items that are affected, such as beta interferon, gold for arthritis, Zyban and all the others. Many members find such problems being mentioned in their postbags. People do not understand why they cannot get the drugs or aid that they are told is available on the national health service. Where they live precludes them from receiving those treatments.
Health boards are squeezed by other pressures such as working time directives and health technology inflation, which rises faster than funding increases. In the end, certain patients lose out. In Grampian, people are penalised further by the Arbuthnott formula, which does not recognise health boards' needs and does not work fairly. My constituents have reason to feel aggrieved because they are being missed out.
The Conservatives want the Executive to follow a policy that we proposed, which is the idea of an exceptional medicines fund. Such a fund would sit at the centre and would allow the funds for approved medicines and aid to be protected from other pressures that the health boards are under. That might be only a short-term solution to postcode prescribing, but we acknowledge that. I agree with Mike Rumbles's suggestion that bulk buying is a way in which to driving down costs. Abroad, digital hearing aids—even when they are acquired privately—do not have the same price tag as they do here.
I urge the minister to tackle the problem of hearing aids alongside the problem of postcode prescribing. It is simply not good enough to deny treatment to many people in society because of where they live. Because the public is informed about what is on offer, leaving it up to health boards to set local priorities is not a satisfactory answer. I thank Mike Rumbles for introducing the debate and I give him my full support.
This afternoon, we debated the social justice annual report, one of the objectives of which is to ensure active, independent and healthy lives for older people. It is common sense that if people cannot communicate fully with others there is a considerable lessening of their ability to take part in ordinary everyday life. That is what lies behind the debate that has been brought so opportunely by Mike Rumbles.
In Mike Rumbles's speech we heard that there will not be a report on the audiology services review for about 12 months. I was told that that report would be available in September; 12 months sounds worse than that. Why cannot we ask the minister to reconsider the issue? Does it take that long to produce a review? Can we draw together the relevant people in the field and consider the need to encourage more people to become audiologists, who—after all—take a bit of time to train? Can we consider bulk buying? Can we pull together the strands of the issue and try to get an early decision?
The issue is not very complicated. Since the Parliament came into existence, reports have been instructed and awaited. Parliament is drowning in reports, but on such an issue we want reasonably urgent action. We might not be able to dot every i and cross every t, but if the matter progresses and some of the 170,000 people that Andrew Welsh mentioned benefit from the use of digital hearing aids, the advantage to society and to individuals who are currently unable fully to take part in society would be enormous.
Not everyone can be helped—we accept that. Some people need assistance in using the devices or in ascertaining whether they need them. In a situation in which one third of people who have hearing difficulties do not use the available devices, the waste that Mike Rumbles mentioned is substantial. Something must be done about that urgently as a health priority. People's ability to be involved in normal society and to communicate is important. I hope that the minister will take my comments on board and try to move the issue towards a decision earlier than the audiology services review promises.
I congratulate Mike Rumbles on securing the debate and I congratulate Robert Brown on reminding us that the debate is not really about digital hearing aids, but about people and how the lack of appropriate, available and affordable technology affects their lives. We should remember that nearly 750,000 people in Scotland are hard of hearing and that perhaps 500,000 might benefit from the technology that is the subject of the debate.
In my business career, blind people and deaf people worked for me. They were highly skilled graduates who worked in computer technology. The blind people coped very well, but the deaf people—who had the burden of not having a visible disability—found it much harder to deal with the world in which they had to operate. Therefore, deaf people and people who are hard of hearing require our support and encouragement.
Digital hearing aids have been available on the NHS for many years; many people would benefit from them, but only two health boards in Scotland prescribe them. As Mike Rumbles said, one of those health boards is Highland Health Board, which has a budget of £100,000 for audiology. I understand that that board prescribes such aids only for children and that it has yet to extend its support to the adult population, but provision for children is good practice. Fife Health Board is piloting a scheme and focusing on audiologists.
Disparity of provision puts many people at a severe disadvantage. A constituent of mine attended a clinic in Elgin—part of Grampian Health Board's area. She could not obtain a digital hearing aid, although her condition was assessed as being such that she would benefit from one. Other people at the same clinic, who were from Inverness, were in a different position, even though they had a similar condition. That represents postcode prescribing at its worst and we should do something about it. The pilot schemes that have been established south of the border show that such aids can improve people's hearing and quality of life.
I am lucky; my hearing is tested every two years as part of the renewal of my pilot's licence, and I can see the deterioration in my hearing every two years. Fortunately, I am not yet hard of hearing, although my wife suggests that I am hard of heeding from time to time. We hope that the Executive—which is clearly not hard of hearing—will not be hard of heeding.
I congratulate Mike Rumbles on initiating the debate. In my time as constituency MSP for Ayr, I have received my biggest mailbag on the issue that is under discussion; there is little wonder that that is the case. In Scotland, 720,000 people are deaf or hard of hearing. As has been said, 500,000 of those people would benefit from hearing aids.
It is a national scandal that fewer than 150,000 of those 500,000 people have hearing aids and that, of them, just over 0.5 per cent have digital hearing aids. To say that provision for the deaf is significantly underfunded is a huge understatement. Not enough money, staff, training, or equipment is available to address the problem. That is why the debate is very important.
For a relatively small amount of money, the quality of many people's lives could be enhanced easily and quickly. Of the 500,000 people who need hearing aids, 350,000 are aged over 60. The neglect of the problem in Scotland is a form of agism that must be addressed.
In Ayrshire, 46,000 people are deaf or hard of hearing, yet the total budget to address their needs was only £393,000 in the previous financial year. I am well aware that that budget was overspent by £88,000 and that it required a top-up from the Scottish Executive, but the fact is that last year, only £481,000 was spent to serve the deaf people of Ayrshire. I will put that into perspective: that is only £10 per deaf person in Ayrshire, which is not a huge amount.
The debate must focus on the future, which means that digital hearing aids must replace analogue hearing aids. It is regrettable that there is in Ayrshire no NHS provision of digital hearing aids—not even for children—yet more than 13,000 digital hearing aids have been fitted in England. The RNID is firmly of the opinion that they must be used in Scotland. That is why I believe that, in the Parliament today, we must agree firmly that the current policy is agist, that it lags behind England and Wales, that the time for talking has passed and that the time to invest in solutions is now.
That is why the Parliament might want to agree today that some of the £86 million that was allocated by the chancellor on Tuesday to public services in Scotland should be spent on audiology. A very small part of that money would make a huge difference to almost half a million people in Scotland. I urge the Executive to consider carefully that proposition.
I congratulate Mike Rumbles for highlighting, through the debate, the issue of the cost to the individual of a digital hearing aid that must be purchased privately.
Digital hearing aids could and should be available on the NHS to all who could benefit from one. In England, through bulk buying, the cost of a digital hearing aid has been reduced from a four-figure sum to about £150. Surely we can do likewise. At the moment, it is possible to get a digital aid in Scotland if one is lucky enough to live in an area in which such aids are provided on the NHS. My constituents in Gordon, in common with many others throughout Scotland, are not so fortunate.
My Westminster colleague, Malcolm Bruce, is the UK vice-president of the National Deaf Children's Society. Malcolm is a long-term campaigner for service provision for deaf people. He knows at first hand the difficulties and service shortfalls that such people encounter because his first daughter was born deaf. In September, Malcolm Bruce and I wrote jointly to Susan Deacon about the necessity for increasing investment in audiology services and for eliminating regional variations in digital hearing provision. Some aspects of her response encouraged us.
She mentioned the Executive's review, which will have input from RNID Scotland and service users. The review will, we hope, be the basis for considerable improvement in services. Susan Deacon also mentioned the "Good Practice Guide on Adult Hearing and Fitting Services", which was issued in March. The guide recommends that digital aids should be supplied when clinical judgment indicates that they would be beneficial. She informed us that 11 different forms of hearing aid are currently included in the national health service in Scotland's contract range. Susan Deacon also said that the Executive is monitoring actively the extent to which good practice guidance is being implemented in the NHSiS.
Today's debate is a good opportunity to put forward the facts and figures about digital hearing aids in our areas and the experiences of our constituents. I am sure that our new Minister for Health and Community Care will find that feedback useful, and that progress will result.
I would like to raise two other matters. The first is the shortage of trained staff. I would be interested to know whether the Executive plans to support the introduction of a degree course in audiology in Scotland, because there is not such a course in any institution in Scotland. That would surely have an impact on the ease with which trained staff could be recruited when they are needed north of the border. When specialist skills are in short supply, there is no reason why newly trained people should have to move far from the area in which they have trained, which will have become an area that they know, in which they might have accommodation, in which their friends stay and where their partners have jobs.
I also want to highlight the importance of deaf-awareness training for staff. I have been appalled by the experiences of deaf and hard-of-hearing friends in hospitals. People who work in a hospital setting—of all sectors of society—should understand the importance of knowing whether a patient is deaf or hard of hearing. It is also important that staff take that fact into account in the way in which they communicate. In a hospital, a patient's failure to communicate or to realise that they have not been heard or understood could, in some circumstances, be a life-or-death mistake.
As I said, I hope that the minister is getting stimulus from the debate to move matters forward on the provision of services for deaf people.
I thank Mike Rumbles for securing this debate. I also welcome Mary Mulligan to her post.
I fully support Mike Rumbles's motion for the Executive to make a commitment to provide digital hearing aids on the NHS. That is long overdue. For too long, audiology services and the deaf have been sorely neglected by Scottish society.
Mike Rumbles mentioned that people had written to MSPs; I am sure that, like me, he has a pile of correspondence. I received copies of questions that constituents had put to the Government, the latest of which is dated 23 November. One of the questions was about pilot schemes. As we all know, the answer given was that pilot schemes operate down south, in England. I ask the minister why schemes have not been set up in Scotland.
Another question concerned the central purchasing of digital hearing aids, which has already been mentioned. The answer that we received was that central purchasing has been possible since June 1999. Why is the option not being taken up? A third question concerned free digital hearing aids from the NHS. The answer that we received was that they were already available free. Why is that option not being taken up? Two speakers—Mike Rumbles got it right—indicated that the problem lies with health boards. That is a big problem.
When members from all parties lodge questions on this issue, the answer that they receive is always, "It is up to each individual health board." I think that the Parliament must say to health boards, "It is time that you gave out digital hearing aids. Go into bulk purchasing. Give them out free." In written answers Susan Deacon indicated that digital hearing aids are available free, that it is possible to bulk-buy and that pilot schemes are on-going. It is high time that we and the Executive told the NHS, "It is time that you took your finger out and got on with it. The hard of hearing in Scotland are fed up waiting."
I hope that the Deputy Minister for Health and Community Care responds to some of those issues. We pussyfoot about too much with trusts and the NHS in Scotland. It is time that the Parliament exercised some authority and gave deaf people in Scotland what they deserve—better digital hearing aids.
I thank members for their kind words and congratulate Mike Rumbles on securing a debate on this topic, which is of considerable interest to many MSPs. If the debate had happened last week I would probably have been sitting beside him. However, as they say, a week is a long time.
I would like to spend a little time filling in some of the background to this issue. In March 2001 we provided NHS boards and trusts and GPs with good practice guidance on hearing aid fitting and services. That guidance was commissioned from the Medical Research Council Institute of Hearing Research and contains recommendations for good practice drawn from the results of research. It was intended that it should be used as a framework for service provision. That framework took account of the wider aspects of the service, such as follow-up assessments and rehabilitation support, and emphasised that this was not a simple technical matter of hearing aid provision.
Members should note that we issued the guidance because we had concerns about a lack of consistency of provision across Scotland. Ben Wallace made a point about that. Changing clinical practice can sometimes take time, so we are actively monitoring the progress of health boards in taking on board the guidance. In fact, the chief executive of the NHS in Scotland has written to the chief executive of each NHS board to ask how it is complying with the guidance. Once we have received all the replies we shall decide what further action to take to ensure that the guidance is followed.
How recently did the chief executive write?
I can say only that he wrote fairly recently. If Mike Rumbles wants a specific date I will get back to him. We are awaiting the replies, which will give us a fuller picture of what is happening.
We want and expect further progress to be made. We all want a good hearing service and we need to accept that there are many different aspects to that. Hearing aid selection is just one of those. In Scotland, a wide range of digital and analogue hearing aids is available. Eleven types of digital aid are available on the NHS through Scottish healthcare supplies. As a result of bulk purchasing, the costs associated with digital hearing aids are much more reasonable than those sometimes quoted. In Scotland the costs range from £120 to £535. That price range overlaps with that of analogue aids.
Not all analogue aids available on the NHS are cheaper than digital aids, so it is not simply a question of the cost of the hearing aid. The use of digital aids has increased over the past two and a half years, since we first established a central supplies contract for digital aids.
As has been said throughout the debate, usage increased from 0.5 per cent to 0.6 per cent within a year. This year the figure has already doubled to 1.4 per cent. I am sure that we all want that figure to increase further if that is the right way to go, but we must ensure that provision of hearing aids depends on the individual's needs.
Our guidance to health boards makes it quite clear that only where clinical assessment shows that only a digital device will meet the needs of a patient should they get one. I have deliberately used that phrase because, as members know, there is some dispute about how many people would really benefit from digital aids. We recognise that digital aids can be the best option in certain situations, but we do not have the evidence to show that they are the answer to all hearing impairment.
Clinicians are divided. Some believe that digital hearing aids are the best option for everyone, but others believe that analogue aids do the job just as well. In fact, many of the analogue aids now issued by health boards are very sophisticated. They are not the outdated aids that have been referred to.
This evening the pilot project in England has been mentioned. As I said, there is uncertainty throughout the United Kingdom about the benefits of digital aids. When the National Institute for Clinical Excellence conducted an appraisal of digital versus analogue aids, it failed to identify any significant differences between high specification analogue aids and certain digital aids. As hearing aid services in England were seen as old fashioned, the Department of Health in England initiated a modernisation programme that included a pilot project at 20 NHS sites. [Interruption.] I am sure that the fireworks that we can hear are not intended especially for this debate. It is important to emphasise that the English project is a pilot project and that it does not cover the whole country. As I said, 20 sites have been identified.
The pilot project is not yet complete, but when it is the results will have to be independently evaluated by the Medical Research Council before any of us can be sure what conclusion to draw from them. The purpose of the pilot is to find out whether providing digital aids for all is the right way forward.
As the minister says, a pilot project is being conducted at 20 sites in England. Would not it be beneficial to set up a pilot scheme here in Scotland? What is the Executive's view on that?
One of the advantages of still being part of the United Kingdom is that we can share knowledge across boundaries. The English pilot project has already been set up and is in operation. We will therefore have an early opportunity to examine its results.
We believe that it is important to look at the broader picture. To that end, we have commissioned a thorough review of audiology in NHS Scotland. The review has a broad remit and will be able to consider all the issues that are important to people with a hearing impairment. It will provide us with an informed, objective basis for decisions.
The review has already established the level and distribution of hearing impairment in Scotland and the extent to which that pattern is reflected in patient referrals. Separate working groups are examining issues affecting adults and children. Those groups will meet two or three times between now and the beginning of January to develop the detail of user perception surveys and to take on board the views of a wide range of stakeholders. Work on gathering together relevant national and international standards is nearly complete.
In the area of deafness, the review will take account of the results of the English pilot project. It will certainly consider hearing aid provision, but the entire procedure will come under scrutiny, not just the issue of analogue versus digital hearing aids.
The RNID, the Medical Research Council, the Public Health Institute for Scotland, and the Clinical Standards Board for Scotland are all working with us to deliver the review of audiology services in Scotland. We feel that that is the right approach and that it will enable us to ensure that the needs of patients are properly addressed.
I do not know whether there are plans at the moment for an audiology degree course in Scotland, but I will be more than happy to respond to Nora Radcliffe's inquiry when I have that information.
The issue at stake this evening is not whether patients receive a digital hearing aid or some other type of aid. The important issue is whether patients' hearing impairment is satisfactorily dealt with and whether the type of hearing aid provided is provided as the result of a clinical decision based on each individual's needs.
I hope that Mike Rumbles accepts that guidance on provision has been issued and that we will seek to ensure that there is a thorough review of how that is being implemented.
Meeting closed at 18:00.