Hearing services are a relic of the Poor Law



Wally Harbert 


Half a million elderly people live in UK residential homes and hospitals; most have hearing problems which substantially increase their risk of developing dementia. Hearing aids can help prevent or delay dementia but they require regular cleaning and their plastic tubing needs replacing every few months. Contrary to assumptions in official guidance, few residents can carry out these tasks.


When my brother received end of life care in homes and hospitals there was seldom anyone available who could clean and re-tube his hearing aid. As he raged against his enforced isolation, he gradually slipped into dementia. 


On enquiry, I learned that many grass roots voluntary organisations across the country are highly critical of health and care services for failing to maintain hearing aids. 


The Care Quality Commission relies on the Accessible Information Standard to judge the quality of services. This requires only that users can access information on health and social care. The Standard is silent on their need to communicate with family and friends, use telephones or enjoy television. What kind of life are they expected to lead in the twenty-first century? 


The Hearing Loss Guidance Committee of the National Institute for Health and Care Excellence (NICE) lacks adequate representation from professionals with experience of meeting the day-to-day needs of adults with hearing loss. The guidance, which it plans not to review until 2023, is seriously flawed. 


No one is in charge of hearing services. Locally, responsibility is fragmented between hospital and community services, between public, private and charitable providers and between health and social care. Coordinated planning and information-sharing are inhibited by internal markets, out-sourcing and separate funding systems. Users in greatest need fall through the cracks. 


Nationally, attempts to clarify policy require emails to be pinged to the Department of Health and Social Care, NHS England, the National Institute for Health and Social Care Excellence and the Care Quality Commission. Each responds with partial answers and no one addresses the gaps between them. Devolved governments divide responsibilities in a similar way. 


The legal framework of hearing loss services is a relic of the Poor Law, based on regulations devised by men in frock coats and wielding quill pens. The right to re-tubing depends, not on your need but on who you cannot hear, how your living expenses are funded, which service you approach and, for some, whether you can attend a health facility in person. If you fund your own care and are immobile as well as deaf you have no entitlement. Entitlement to a hearing aid does not bestow a right to have one that works. 


It would be difficult to design a more irrational or perverse system but some providers fight their way through this bizarre labyrinth and ignore restrictive rules to offer first class care. The cost of bringing all services up to the standard of the best would be modest and can, if necessary, be met by local voluntary groups which are already active in many areas. 


We cannot rely on a Westminster initiative to address the problem. However, by joining forces, local service providers can, if they choose, put an end to the current unsatisfactory state of affairs.


May 2020. 



Your views are welcome. Please email agecare@btinternet.com or write to 9 Button Street, Frome, Somerset, BA11 3DR. 


Wally Harbert is a retired UK Director of Help the Aged and former adviser on services to elderly people to the UN and WHO. 


Posted May 2020.