Community Audiology

Luke Evans Excerpts

Thursday 18th December 2025 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

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.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers. I start by thanking my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) and congratulating him on securing this important debate. Having now been in the same room as a specialist in ear, nose and throat, a former GP and a vet, I am not sure that I am entirely qualified, and I approach this debate with some trepidation. I certainly enjoyed the debate and, as the Father of the House rightly said, it was a privilege to be able to hear some of the insights, direct experience and expertise of hon. Friends and Members.

My hon. Friend the Member for Uxbridge and South Ruislip has also been doing a huge amount of good work in promoting the flu vaccine ahead of winter, in his constituency and more widely, and I pay tribute to him for that. It was a pleasure to visit his constituency a few weeks ago, where I met the incredible team at the Pembroke centre in Ruislip Manor to hear about how they are delivering, designing and developing their thoughts about neighbourhood health hubs and the neighbourhood health service, which will be a pivotal part of our 10-year plan.

The Royal National Institute for Deaf People estimates that one in five people in the UK—almost 12 million adults—are deaf, have hearing loss or experience tinnitus, and by 2035 that figure is projected to rise to over 14 million. For people with cognitive disabilities, hearing loss can have a real impact on their quality of life, causing confusion for people with dementia, making communication and social interaction more difficult and increasing loneliness and isolation.

That is why our community audiology services are so important. They represent a comprehensive range of hearing care delivered in local, accessible settings, such as GP surgeries, community clinics and community diagnostic centres. They help people of all ages, offering assessments, hearing aid fittings and support for those with tinnitus and balance issues. They advise on equipment such as amplified telephones and alerting devices, while working alongside occupational therapists to support people to stay independent. They form part of a wider team with speech, language and other community services, acute care, and the ear, nose and throat department for issues that cannot be managed in the community.

Community audiology services face challenges, particularly on waiting lists and inequality of provision. Members across the Chamber raised some of those points. The Father of the House rightly pointed out that there are 6.7 million people who should use a hearing aid but do not. We must overcome the stigma associated with hearing loss.

The hon. Member for Honiton and Sidmouth (Richard Foord) was right to talk about the connection between hearing loss and the propensity for falls. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) shared his tremendous expertise as an ear, nose and throat surgeon, and I thank him for his insights about the Hear for Norfolk project, which is a very interesting model indeed. Perhaps we can follow up on it in the new year.

The hon. Member for Winchester (Dr Chambers) gave a remarkable exposition on hearing loss in dogs—I have to say that I did not have that on my bingo card for this afternoon—from which we all learned a tremendous amount. He also made a number of important points about hearing loss in humans, and we absolutely take them on board.

The hon. Member for Hinckley and Bosworth (Dr Evans) rattled off a number of questions for me, and I desperately tried keep track of them. I got some of them and did not get others, so I will happily write to him on the points that I am unable to address now. He raised an important point about self-referral, which of course depends on local commissioning arrangements. There is inequality and unwarranted variation in the ability to self-refer. We want more self-referral. We think there are opportunities in upgrading the functionality of the NHS app. Our objective is absolutely to be able to do this without having to go through a GP. There are some technology-related solutions, but I want to assure him that there is no conscious decision from the Government to deprioritise self-referral; I just think that there are some variations.

The old chestnut that we are constantly trying to crack is around devolving to ICBs the power and agency that they should have because they are closest to the health needs of their population, while ensuring that they are clear about the outcomes, frameworks and standards that we expect. We honestly hold our hands up and say that we have not got that right in all cases, but we are committed to self-referral as a principle and as a really important part of the shift from hospital to community.

On ICB budgets, we have secured £6 billion through the spending review process for capital upgrades. A lot of that will help us to ramp up what we are doing on community diagnostics. That is one way to square the circle around the investment that we need on the ground for ICBs to be able to do more in terms of the services they provide by improving the equipment, the kit and the technology they have. Part of the answer to the hon. Member for Hinckley and Bosworth’s question relates to capital investment really helping to boost the services provided.

The workforce plan is coming in the spring of 2026. I absolutely hear what the hon. Member says about the need to move forward on that. It has been a complex process. Obviously some of the changes and restructuring around what we are doing on NHS England have also had an impact on the process of putting the workforce plan together, but I am reliably informed that that will be in the spring of 2026.

Timely access and effective support to services can make all the difference to someone’s quality of life, wellbeing and independence. As part of our effort to shift care from hospital to home, this Government want to support people to live independently in the community, and community audiology will play an essential part in making that happen. Community audiology is commissioned locally by integrated care boards. Funding is allocated to ICBs by NHS England. Each ICB commissions the services it needs for its local area, taking into account its annual budget, planning guidance and the wider needs of the people that it serves.

This year, my right hon. Friend the Chancellor confirmed the Government’s commitment to getting our NHS back on its feet and fit for the future, with day-to-day spending increasing by £29 billion in real terms over the next five years. By the end of this Parliament, the NHS resource budget will reach £226 billion. That funding will support the growing demand for community health services, including audiology. It will help integrated care boards to expand diagnostic capacity, invest in local estates and equipment, and sustain the workforce needed to deliver high quality hearing care for patients of all ages. For the first time, we have published an overview of the core community health services, which include audiology, for ICBs to consider when planning for their local populations and commissioning processes.

Our medium-term planning framework for the next financial years sets out our ambition to bring waiting times over 18 weeks down, develop plans to bring waits over 52 weeks to zero, and to increase capacity to meet growth in demand, which is expected to be around 3% nationally every year. We are asking systems to seek every opportunity to improve productivity and get care closer to home, from getting teams the latest digital tools and equipment they need so they can connect remotely to health systems and patients, to expanding point-of-care testing in the community. Systems are also asked to ensure that all providers in acute, community and mental health sectors are onboarded to the NHS federated data platform and use its core products.

Our 10-year health plan sets out how we would make the shift from analogue to digital by making the NHS app the digital front door to services. We will make it easier for patients to access audiology services through self-referral. This will transform the working lives of GPs, letting them focus on care where they provide the highest value-add. This is how we will make sure everyone can self-refer—not just the most confident and health-literate. Patients can access NIH-funded audiology services directly without having to wait for a referral from their GP. That means improved access to care and shorter waiting times.

My hon. Friend the Member for Uxbridge and South Ruislip and other hon. Friends stood, as I did, on a manifesto to halve health inequality between the richest and poorest areas of our country. I know he will agree that access should not be based on where we live. A key part of our elective reform plan, published at the start of the year, is transforming and expanding diagnostic services so we can reduce waiting times for tests and bring down overall waits. NHS England is working closely with services to improve access to self-referral options, aiming for a more consistent offer right across the country.

[Dr Luke Evans]

I am grateful that a comprehensive plan is coming forward. One problem we have is joining the leadership up. The Kingdon review, which was launched in May and finished in November, made 12 recommendations that will help align with all the missions the Minister is bringing forward. Can he tell us when the Kingdon review will be accepted and analysed by the Government, and their position on the recommendations, because it is a key thread to delivering all the ambition that he has rightly put forward?

[Stephen Kinnock]

I can—we are absolutely committed to responding to the Kingdon review next year. We are working on pulling together our response to the report. It is extremely important, and there are serious lessons to be learned from it. We think Dr Kingdon has done an excellent piece of work, and we are very keen to build on it and take it forward.

Community diagnostics, such as local hearing assessment clinics and testing in community settings, are being rolled out more widely through the expansion of our community diagnostic centres. We are opening more of these centres—12 hours a day, seven days a week, offering more same-day tests, consultations and a wider range of diagnostics. I am very proud that we now have 170 CDCs across England.

Almost 2 million audiology assessments have been carried out by NHS staff since this Government took office, including 136,000 tests in October—the highest number of audiology tests for a single month in the history of the NHS. This is a crucial step in supporting the NHS to meet its constitutional standards and deliver quicker care to patients. I also want to salute the work of the Welsh Government, who have been pioneers in many respects with their plan, published this week, showing how Wales is also leading in audiology services on care in the community, training and infrastructure.

The hon. Member for Hinckley and Bosworth asked about the Kingdon report, and in this debate on audiology services, I must take this opportunity to thank Dr Camilla Kingdon for the excellent review that she chaired into failures in children’s hearing services. As I have just told him, the Government are committed to responding to the recommendations made by Dr Kingdon, and we will publish a comprehensive response next year.

Community audiology services face challenges, with long waits and inconsistency in access to services, but we are taking action through the medium-term planning framework, by expanding community diagnostic centres and as an integral part of our 10-year plan. My hon. Friend the Member for Uxbridge and South Ruislip and I come from a political tradition based on solidarity, and this Government stand for a health service that leaves no person behind. I know that he shares my determination to get timely access to community audiology services for all 12 million of our compatriots who need them.

I thank my hon. Friend once again for bringing forward this extremely important debate, and I thank all Members who have spoken. It only remains for me to wish you, Mr Vickers, as well as your entire team and everyone else in the Chamber, all the very best for Christmas and the new year.