News Item

Friday 19 October 2001

Jacqui Smith, Health Minister speaks at RNID event – Breaking the Sound Barrier

Full text of speech:

I am pleased to be able to contribute to your conference, and to take this opportunity to say a little about the initiatives underway, across Government, to benefit people who are deaf and hard of hearing.

I would also like to say something about two specific projects for deaf and hearing impaired people which demonstrate that commitment in practice - hearing aid modernisation project, and newborn hearing screening project.

I am pleased to say that we have a great deal happening across Government to improve services for people with disabilities. Those various initiatives share core principles - promoting independence, tackling inequalities, improving access, and putting patient/user at the centre. People don’t organise their lives to fit Governmental administrative boundaries, nor should they.

We recognise the importance to partnership in these initiatives – of Government Departments working together, and of partnerships with users and their representatives. It is only by bringing together all stakeholders that we can make a significant difference to the lives of disabled people.

Initiatives span many fields, and I want to touch on them briefly.

In Employment we have seen the introduction of the New Deal for Disabled People - a joint initiative between DWP and DES, which was piloted last year. By end of Jan 2001 6,500 people with a wide range of disabilities had been helped into work

DH has asked councils to work together with partner agencies and with disabled people to develop Welfare to Work Joint Investment Plans for disabled people – an initiative intended to help people prepare for entering employment as well as remaining in employment. The initiative is intended to cover all disabled adults including those with sensory impairments.

While many of the first year Joint Investment Plans made specific reference to the needs of people with sensory impairments, not all of them did. The feeling that those with sensory impairments may be less likely to experience support related to employment needs is also borne out by the findings of the inspection on Welfare to Work carried out by the Social Services Inspectorate in 2000 (Making it Work – published this September). This is an important issue and we intend to make it clear in any guidance produced for the second year of this initiative that the needs of sensorily impaired people must feature in local Welfare to Work Joint Investment Plans.

Before I was in the DH, I was in Education. You will know that the Special Education Needs and Disability Bill received Royal Assent in May this year, SEN provisions will strengthen existing legislative framework. Disability rights will be introduced in schools and post-16 education.

During the passage of the SEN and disability Bill in February 2001 (now The Act), Baroness Blackstone gave a governmental commitment to establish a multi-agency working party to develop practical guidance for the range of professionals involved in the identification of and support for children with disabilities in the age range birth to 2 and their families.
This joint DfES and DH working party has been established in conjunction with the Special Education Consortium and is chaired by Paul Ennals, Chief Executive of the National Children’s Bureau. The working party has representation from a number of national voluntary organisations including the RNID.
The working party is meeting on a regular basis to pull together a draft document for consultation at the end of December. It will use examples of good practice from around the country to illustrate where and how services are currently meeting the needs of this vulnerable group of children. It is proposed that final guidance will be issued in March 2002.

We are also taking action to improve leisure facilities for people with hearing impairments. We have increased access to television for people with sensory impairments, following the DCMS review of the requirements set out in the Broadcasting Act 1996 and in Statutory Orders for the provision of subtitling, sign language and audio description services on digital terrestrial television (DTT). Following the review, the target for the provision of subtitling on DTT has been raised from 50% of programmes by the tenth anniversary of the start of the service to 80%. We are also committed to extending the targets for subtitling, sign language and audio description services on DTT to digital cable and digital satellite television.

The DCMS funding Agreement with the Arts Council of England makes clear the Government's commitment to increasing access to the arts.

Within the Department of Health we are taking forward the modernisation of Community Equipment services. The Government is providing £105m to improve NHS community equipment services from 2001 to 2004 – additional money is also being included in the allocation to local councils to cover their part in the expansion of these services. The aim is to integrate health and social services provision and to increase, by 50%, the number of people benefiting from disability equipment by 2004. The guidance issued in March to those involved in the initiative recognised that provision of equipment to people who are deafblind, deaf and hard of hearing has often been inconsistent from one area to another. It specifically reminds authorities that items such as vibrating pager systems, assistive listening devices and the like are appropriate to be supplied by statutory agencies.

The Quality Protects programme, launched in September 1998, is designed to improve the management and delivery of children’s social services. It is a key part of the Government’s wider strategy for tackling social exclusion and focuses on working with disabled children.

£60 million over the next 3 years will be focused on improving provision for disabled children.

I would like now to talk about Modernising Hearing Aid Services. Good progress is being made on the pilot project. This has been an innovative way for the NHS to implement a pilot project, with RNID responsible for project management, working in partnership with my Department and other stakeholders. The benefits of this way of working have been clearly demonstrated and – I think – will give us lessons for other parts of the Department of Health.

Our aim is to test out the benefits of providing leading edge digital hearing aids on the NHS as part of a modernised service.

We have made a very positive start. It is only a little over a year ago that my predecessor, John Hutton, announced the Modernising NHS Hearing Aids pilot project. Today, 20 NHS Trusts are routinely fitting digital hearing aids. By end September 10,552 aids have been fitted and almost 13,000 people have been assessed.

We must not underestimate what an achievement this is, involving not just new technology but incorporating new ways of working. I want to congratulate everyone who has helped to make it happen, especially audiology staff who have embraced the challenge and worked really hard to make changes happen.

I would also like to acknowledge the central role RNID has taken in the management of this project. Your experience and expertise has been, and continue to be, invaluable. It is essential that we continue to develop this partnership and this innovation. I would also want to recognise the contribution of other partners –

- Institute of Hearing Research (evaluation)
- NHS Purchasing and Supplies Agency (who have been instrumental in obtaining the best possible deal on price of quality hearing aids and equipment), and
- National Deaf Childrens’ Society (who have provided support on paediatric project and neonatal hearing screening)

James is right. The introduction of digital technology is important. But, as I have mentioned, modernisation is about more than hearing aids – it’s about an updated infrastructure and new equipment to support user-friendly processes fit for 21st century

Along the way, NICE guidance on hearing aid technology was issued in July 2000. It recognised that evidence about digital hearing aids was not available at that time, but NICE will revisit guidance following the project.

The guidance was well received by the Department of Health and we support the recommendations that:

- the full range of hearing aids in the current NHS range should be available at all hearing aid centres;
- the hearing aid offered to an individual user should be based on a careful matching of the aid to the clinical need; and
- that there should be increased user choice, improved access, improved patient processes and reduced waiting times .

These are all points which our modernisation project will try to address.

We have provided funding to health authorities to support the implementation of NICE guidance and have made clear that health authorities should take NICE guidance fully into account in their decision-making processes. We are currently preparing to implement our manifesto commitment to place statutory obligations on the NHS to fund drugs and treatments recommended by NICE.

For the modernisation project, the Government has provided additional funding to support the pilot project, put in place value for money purchasing contracts for hearing aids, patient management systems and equipment.

By next March we expect that in excess of 18,000 people will have digital aids on the NHS.

We are now looking carefully at the best way to move forward. The Institute of Hearing Research is evaluating the pilot project very carefully – looking at

- what are the most effective hearing aids for NHS patients?
- what are the best ways to supply hearing aids?
- how can a modern hearing aid service be delivered to NHS patients?

Any equipment that the NHS provides can be judged on the difference it makes to those who use it, and early evaluation reports from the pilot sites look promising. Although at this stage data is based on limited data from pilot sites, it is very encouraging that, based on small samples, people with digital aids are reporting improvements in hearing, and that people with digital aids are wearing them more – with fewer ending up languishing in a kitchen drawer.

We need to use IHR findings to inform our decisions about the benefits of making these modernisation changes more widely available throughout the NHS. While we appreciate that people want digital aids to be available everywhere, now, we must ensure we have got it right first – that’s why we are testing it out.

We have earmarked funds to begin roll-out subject to favourable evaluation. We have already said that up to £25m will be invested by 2003/04. Tough decisions about funding of all NHS services need to be taken as part of the Spending Review process, and we need to balance money for hearing aid modernisation against other pressing priorities. So we need to be clear about what might be achievable and the pace at which improvements might be introduced.

But let me make it clear that we know it’s not just a matter of putting more money into audiology, welcome though I know that would be. There are other key issues about additional patient demand and NHS capacity to deliver change on the ground. To deliver we must look at all these factors.

We know it will not be all plain sailing. It is important that we recognise there have been problems and we want to continue to work with RNID to support audiology departments to help overcome the challenges.

The key challenges that we as a Government, and you as providers and users of audiological services, are waiting times, and linked to that, shortage of skilled staff in audiology departments.

The NHS Plan sets out an agenda to increase the number of NHS professionals in many specialties and across many professional groups. We know that we can’t just keep delivering services in exactly the same way as we did 20 years ago. We can’t even deliver services in the same way we did 2 years ago. So, we are working to develop a better, more responsive service for all those who are deaf or hard of hearing.

In the longer term we have a Departmental working group ensuring that all existing audiology training programmes are maintained, and developing new degree level courses in audiology to create a single programme for professional training. We hope that this, together with the modernisation programme, will make audiology a more attractive career option in the future.

In the short term we need to look at innovative use of skill mix. Some Departments are already doing this and Action on ENT are now sponsoring a project looking at the role of assistant technical officers. For example, in Leeds, assistant technical officers have a clearly defined role in supporting the assessment of patients, fitting digital hearing aids and providing basic counselling. They are supervised to ensure that quality of care is not compromised.

It is not surprising that people with hearing impairment want digital aids. We recognise that NHS provision will lead to increased demand. But most hearing aid wearers are in their 70s – and they don’t want long waiting times for assessment and fitting. A recent RNID project report recognises that, although many participating Trusts worked hard to reduce their waiting times before the project started, since beginning to fit digital aids, waiting times have risen.

We have to be prepared to address these issues. In order to do so we want to encourage better, smarter ways of working, modernised patient processes supported by IT. An important element of this is Action on ENT, which is encouraging innovation and spreading best practice.

To that end I am pleased that the modernisation project is establishing closer links with the ‘Action on ENT’ / Modernisation Agency. Clearly we have areas of common interest – notably waiting times; staffing/skill mix; service innovation and improvement.

Similarly, we need to create links elsewhere to explore more innovative ways to overcome staffing and waiting times challenges. These are issues that are common to many other areas of the NHS. And we have already shown that we are willing to think flexibly, to look at innovative ways of increasing capacity. As Alan Milburn has said, “We need every bit of help we can get to renew the NHS. That’s why we should not close our minds to the NHS and the private sector co-operating where private sector expertise or finance can bring benefit to NHS patients.”

We want to test out ways in which private sector might be involved – how they might support audiology departments and boost NHS capacity to deliver benefits of a modernised service to hearing aid users as quickly as possible.

I must make clear what we are - and what we are not - talking about here.

We are not talking about privatisation – patients will still get an NHS service

We are not talking about devaluing the role of NHS audiologists – we all know they are key to delivering better services

What we are talking about is looking at partnerships that could benefit hearing aid users. At supporting NHS audiologists to make best use of their special skills and expertise.

To succeed we must be willing to explore these new links. That is why today, I’m announcing that we want to fund a very limited pilot to evaluate ways in which hearing aids dispensers might be involved. We want to find effective ways of boosting NHS capacity so that access to hearing aid services is improved. And we want to work with RNID and other partners to plan and manage this project.

The other Departmental project I want to talk about is the new screening programme to introduce newborn hearing screening to replace the infant distraction test. This new programme which will help identify more of the 840 children born with hearing difficulties each year, at a much earlier stage.

Earlier detection of hearing difficulties has been proven to improve language and communication skills and subsequent educational achievements and quality of life outcomes.

It links particularly strongly and clearly to our commitment to improve outcomes for all.

An evaluative pilot programme has been established and will run for 12 months, followed by a progressive implementation across the NHS in England over the next 3-4 years.

Over £3m has been invested in the last 18 months, with more to follow from 2002/3.

The pilot will help facilitate and improve joint working between the NHS, the education service and social services in the care and follow up of children with hearing difficulties, and their families. Joint working is key to our success – not just for Newborn Hearing Screening, but also for modernisation of the paediatric hearing aid service more generally.

I hope this summary of some of the work that the Government is undertaking or supporting helps to assure you that the Government is committed to human rights for people with disabilities, and practical improvements for people who are deaf and hard of hearing. We will continue to work in partnership with Voluntary Organisations (RNID, NDCS) who can make sure the patient’s voice is heard and contribute a wealth of experience and expertise.

There are some really exciting projects taking place– NHS piloting provision of leading edge technology supported by modernised patient pathways. If we continue to work together, I am confident that we will be able to see real improvements.