Dr Luke Evans

It is a pleasure to serve under your chairmanship, Mr Vickers, and I wish you and your team a merry Christmas. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for inadvertently creating what seems like a medical symposium; I feel as if I am back at one of my Christmas grand rounds—they often used to pick something a little bit strange and wacky to debate. I did not quite expect to be talking about spaniels’ ear canals, but I enjoyed the flashback none the less. The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) rightly talked about couples. When I was a GP, I saw couples become yin and yang, supporting each other on the basis of who had the hearing loss, who had the brains and who had the dexterity. If one of those problems is not sorted, there can be real impacts for the others. We should consider that when we deal with patients. The hon. Gentleman’s point about drawers of waste was a personal hobby horse of mine too—though it was not hearing aids, but often medication brought back to me, or seeing thousands of bandages or eye drops left over when I went on home visits, for example. That is a really important point and the NHS is not very good at picking up on it. I thank the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), for raising the issue of stigma. My grandfather was particularly bad and stubbornly did not want to get a hearing aid, and even when he did get it, he would not wear it. My right hon. Friend also joked about his wife not hearing him, which reminded me of “Captain Corelli’s Mandolin”; at the start of the film, the pea is taken out of the ear, but at the end, because of all the nagging, he is desperate to get the pea reinserted. My right hon. Friend also raised the issue of workforce, which is incredibly important when it comes to trying to solve some of these problems. The hon. Member for Uxbridge and South Ruislip set out clearly and coherently both the landscape and where we find ourselves. That is really important because, when people think about care delivered close to home, hearing loss services are among some of the most visible examples on the high street and in our community settings across the country. I visited the Specsavers on Hinckley’s high street, as well as the pharmacy in Newbold Verdon, only a couple of months ago to see what they provide. There is a real opportunity to bring care towards people, which makes high streets a good bellwether for this Government’s ambition on prevention and community care and how that is being translated into practice. There are three issues I would like to press the Minister on. The first is the funding pressures on the ICBs, the second is access and self-referral, and the third is national oversight and data. On access and self-referral, under previous NHS operational planning guidance, ICBs were asked to increase direct access and self-referrals into audiology services. That was a good move; it meant that people concerned about their hearing could go straight to specialist care without needing to see a GP first. In many areas, that has been a success. However, as we heard during the debate, 12 ICBs that commission hearing loss services still require a GP referral. That adds delays for patients and places unnecessary pressure on general practice, not necessarily for any clinical benefit. Against that backdrop, it is a little disappointing to see that self-referral was not included in the most recent operational planning guidance for 2025-26, nor in the medium-term planning framework. The question is why. Would the Minister explain why self-referrals seem to have been deprioritised, and what concrete steps the Government are taking to ensure that access to audiology does not depend simply on where someone lives? On funding pressures and core services, Members have rightly highlighted the significant variation in access to routine audiology services, particularly earwax removal. In too many parts of the country, people are either being pushed back to the ENT departments or told to pay privately. I am glad that we have an eminent surgeon in the Chamber, the hon. Member for Bury St Edmunds and Stowmarket; from a GP’s perspective, I understand why some were reluctant to go back to having their ears syringed and I often dealt with complaints about why it was not suitable, as suction is the gold standard. The question is how we provide that in a way that is deliverable to the community and provides to the patients, but is also at least cost-neutral for primary or secondary care. There is a conundrum there. That situation will be made worse, as the Father of the House pointed out, by our ageing population. When ICBs are under pressure and their budgets are changing—they are being cut by 50%—how do we ensure that that it is deliverable? That poses the question of how sustainable it is to place the responsibility of the full range of audiology services on ICBs, considering they are under constraints, and how will the Government square that circle. There is also the opportunity of public-private partnerships and neighbourhood centres to help to deliver audiology services. That could come as sites or services. I would be grateful if the Minister could set out what his vision is in this space, considering we are trying to take a leftwards shift. There are also opportunities for new thinking. As I mentioned, I went to see a pharmacist. What supports have been put in place for new providers to come in? Pharmacists seem keen to be able to take on more services, and they often have sites directly in the heart of our communities—the closest place to our residents. Is there some consideration of what can be done to innovate in that space? On data, oversight and accountability, one of the most striking features of audiology is how difficult it is to assess the performance nationally. The Government were right to set out their ambition to meet the NHS standard that 92% of people should wait no longer than 18 weeks from referral to treatment, and in most specialties we can clearly see how the system is performing against that ambition. However, in audiology it is harder, especially as the referral-to-treatment waiting time data, which was paused during the pandemic for understandable reasons, has since been retired by NHS England. Looking ahead, given that the Government have confirmed their intention to bring forward legislation to abolish NHS England, with the statutory functions being taken into the system, will the Minister consider looking again at reinstating the referral-to-treatment waiting time data for direct audiology as a way to monitor the leftward shift that the Government are pushing for? If so, will that be done at ICB level or under the Department of Health and Social Care? I would be grateful if the Minister could clarify two points. First, when does the Government expect to introduce the legislation in 2026? Secondly, it would be helpful to understand when we can expect the workforce plan: we were told that it was coming in the summer, then the autumn and, now that we are on the last day of business before Christmas, I expect it is coming in the new year. Knowing when that plan is coming, and how audiology will play a part in that, is really important. Given the Kingdon review only came forward in November, it is unfair of me to ask whether the Government have fully assessed it yet. The review had 12 recommendations and also pointed out the oversight, and there is a question about how that will be resolved. With all the changes to ICBs, NHS England and the Kingdon review, I would be grateful to know when we will likely hear whether all recommendations have been accepted and will be resolved. Audiology may not always attract attention in this House, but it is a vital part of our community healthcare and a real test of the Government’s commitment to prevention and access. I hope the Minister can provide clarity on the questions I have asked today. I wish you, Mr Vickers, your team, your colleagues, everyone in this House and my constituents a very merry Christmas.