I acknowledge the tolerance of the House in permitting me to raise at this late hour the question of the provision of a better service for the deaf. This debate originates from the statement made on 9th July 1973 by the then Secretary of State for Social Services, the right hon. Member for Leeds, North-East (Sir K. Joseph), in which he stated that a behind-the-ear type of hearing aid would become available under the National Health Service. Up to then, the only issue of hearing aid was the body-worn aid, or what was irrevertenly called the "bosom-basher" hearing aid, which had its origin in about 1948. It would be for the benefit of the House if I gave briefly the background to events in the interim period.

From 1948 until 1973—over 25 years—the only National Health Service hearing aid was of that type. The hearing aid industry which developed over the intervening 25 years and which currently has 170 dispensers and 1,500 people engaged in the production of hearing aids in this country, developed and produced several varieties of hearing aids, behind-the-ear and of similar pattern, of much more sophisticated design. The people in the industry endeavoured to make good the deficiency in the style of aid offered by the National Health Service, both in its sartorial effect and its overall efficiency. This they did with a certain degree of satisfaction. It can be seen from the figures for sales or prescriptions provided by these people that they produced something that people wanted which was much more attractive than the aid offered under the National Health Service.

The industry, however, had its disadvantages. It had what we might term its "cowboys"—those who sold where they could and how they could, and who abused this section of the industry. To offset this, the dispensers and consultants set up their own trade association, which endeavoured to discipline or to police the industry. The association has done that with a reasonably high degree of satisfaction both to the industry and to its customers. There is also a manufacturers' association which until recent months was independent of the dispensing side or the consultancy side of the business. I emphasise that from the increased sales of their products—"sales" is the operative word in this case—it must appear that those who suffer from being hard of hearing were fairly satisfied.

As a result of the Minister's statement in July 1973 there were two meetings with the trade associations. The first was in August and the second in November, with the then Under-Secretary. At the first meeting the trade was asked what services it could offer, what sort of distributive system it had, and so on. The second meeting was wholly unsatisfactory. It amounted to more or less saying, "Thank you for coming last time, nice to have met you, goodbye." In other words, the associations were not consulted on what virtually amounted to notice to quit.

It was at this juncture that I was involved, as a direct result of an approach by a constituent of mine, Mr. E. Slater of Rawtenstall, who is a consultant in hearing aids and a hard-working and honest man if ever I met one. I wrote then to the then Secretary of State about the matter, saying: The difficulty is that the private sector of the hearing aid industry in so far as audiologists are concerned will be put out of business since all hearing aids will ultimately be supplied through the hospital service. Whether the consultants give good or bad service, whether they like it or not, their livelihood has been taken from them. I would respectfully suggest that this is one step towards a national health service which will in due course eliminate freedom of choice and the private sector—it is logically very unlikely that these consultants will be able to find sufficient private practice to exist, much less remain in business! Obviously the majority of the consultants have great experience, are well qualified and have served the community beneficially over a number of years. If this is to be the policy of HMG for hearing aids, then surely it is not unlikely that it will be extended to other beneficial services and equipment supplied exclusively through the NHS. I shall be pleased to hear what action the Department propose to take to safeguard the consultants, that the fears of the Hearing Aid Industry Association are unfounded, and that there will be no further inroads by the Department into the private sector. A number of hon. Members from both sides have received what can only be described as a brushoff reply. As a result of that I tabled a Parliamentary Question asking for a complete list of hearing aid designs approved by the Department for the National Health Service. The reply was more than slightly offputting. I was told by the then Under-Secretary that My Department has so far approved two behind-the-ear hearing aids for general issue through the National Health Service. One, model OL67 manufactured by Oticon Ltd., in Denmark, is currently supplied to school children. The other, which will be the first of this type to be issued to adults, will be available next year and will also be manufactured by Oticon Ltd., but in a development area in Scotland."—[OFFICIAL REPORT, 12th December 1973; Vol. 866, c. 140.] I was also advised that the Department would not be offering existing or other private qualified consultants contractual employment but that these people would be given the chance of employment in the health service as dispensers provided they met the requirements of the Whitley Council. I suggest that that is not in the least a satisfactory answer, bearing in mind that some of those consultants have been in the industry and the profession for 25 years.

I followed with a further series of Questions, and on 20th December I received a reply to a Parliamentary Question in which I asked for a register of qualified consultants or qualified audiologists and I was advised that the Department did not maintain such a register. Perhaps I am very thin-skinned, but I took a dim view of that reply because what it did not tell me in answer to my Question was that the then Department of Trade and Industry maintained such a register. The Department of Health and Social Security were not being, to say the least, helpful.

On the same day I asked another Question of the Secretary of State for Social Services—whether he would provide facilities for British manufacturers to tender for the supply of all types and models of behind-the-ear hearing aids approved by his Department". The reply read: British manufacturers were able to tender and a number did for the behind-the-ear hearing aids to be supplied through the National Health Service. Some tenders are still under consideration and an opportunity remains for these manufacturers to submit models for approval and supply."—[OFFICIAL REPORT, 20th December 1973, Vol. 866, c. 377.] There is, however, another issue arising, namely, that a contract had already been placed with Oticon, in Denmark, on 28th November, for these identical hearing aids. In other words, somebody, somewhere, was misleading. Three weeks or so had gone by and this information was not available.

There is another factor still—that the British manufacturers can offer at least the same manufacturing facilities as those of the Danish company. They can go further. They do not require Government finance for a factory in a development area in Scotland for these bits and pieces to be made.

Such was the picture. I suggest that the Department was less than frank right through the issue. I have already detailed the information as to the numbers ordered. It was 150,000–60,000 in the first year and 90,000 in the second. I am given to understand that there are no further contractual arrangements with Oticon but I do not feel that it was in any way fair that the Department should overlook British manufacturers in this matter.

Now we come to the main issue—is the Department of Health and Social Security fully equipped and able to meet the needs of the service? What we all want—I am sure that the Minister will confirm this—is to give first-class service to the public as a whole.

One point must be put on the question of the register: I should like confirmation of the fact that the Oticon units offered are suitable only for the medium-deaf and not for those seriously affected. As a layman, I am given to understand that those who are medium-deaf or less can have surgical or other remedial treatment, which would perhaps dispense with those types of equipment.

In a letter which I received in February from the then Under-Secretary I was told that the whole of the distribution would be effected by the National Health Service, which, on its own admission, was short of staff qualified for the purpose. I do not see why it is necessary to give those who work in the Department a slap in the face, which is what the methods adopted amount to.

On 25th March this year, a departmental circular, reference H/D11/01, was sent to area health authorities. Completely contrary to the information which has been given, it suggests that the autho rities should make a deal with the private sector and ask it to assist in the provision of hearing aids. It says: If the necessary fitting skills are not available within the National Health Service, the dispensing of these aids should be carried out by dispensers registered under the Hearing Aid Council Act 1968. Local arrangements for this purpose should be made by Supplies Officers, subject to the approval of the Otologist. That is a complete reversal of procedure. The circular, which came into my hands by accident also says: Some children will be suited only by other types of special hearing aids and it will be necessary for these to be purchased from and fitted by private dispensers. Local arrangements for this should be made by Area Supplies Officers on the recommendation of an Otologist. We have a reversal of policy there.

Everybody wants to give the best possible service to the deaf—to those who are not so well placed in life. What I do not understand and do not like is the attitude that this will be a 100 per cent. National Health Service matter. There may be a political slant; I do not know. The National Health Service admits that it does not have all the dispensers. It may not have all the ear, nose and throat specialists available to recommend. Therefore, it goes back on what it said previously, and says very quietly to the area health authorities, "Make a quiet deal with private practice. Use it while you can, and when you are equipped to do the job yourselves throw it overboard." That is the impression created by this correspondence. I hope that I am wrong in my assumption.

I should like to see arrangements similar to those in certain European countries, whereby the otologists continue to operate in private practice, but the recommendations are made to them by the ear, nose and throat specialists. They are told, for example, "Mr. Smith requires this type of equipment, and you are authorised to supply it".

There is also the question of servicing, of replacing batteries, and so on. I understand that the National Health Service would not object to the private sector's supplying replacement parts. I advocate a partnership between those who have given good service over the years—many of them are small independent practitioners—and the National Health Service. By team work we can achieve the results to which we all look forward. I hope that the Minister will support my plea.