I am pleased to have the opportunity to raise the issue of war veterans who suffer from noise-induced hearing loss as a direct result of their service. I say that not least as someone who has lifelong experience of hearing impairment among close friends and family members and who has some hearing impairment himself, although I was lucky enough to get a pension before the cut-off, which I shall talk about.
It is more than eight years since the situation was last discussed in Parliament, but it has continued, with many thousands of veterans feeling that their sacrifice has gone unrecognised. Members of the House have consistently expressed concern about the way in which many ex-servicemen and women who have suffered substantial hearing loss as a result of their service are being denied recognition. In the 2005-06 parliamentary Session, 123 Members signed early-day motion 306, adding to the call for changes to the way in which the Government treat veterans with noise-induced hearing loss.
Veterans with noise-induced sensorineural hearing loss have several grievances in respect of the war pensions scheme. There are concerns about the scale used, which links 20 per cent. disablement to a 50 dB hearing loss, which many consider too high. There are also concerns about the requirement that veterans have reached that level of loss when they leave service, which means that the possible long-term effects of exposure to noise are not taken into account.
In the time that we have, however, I want us to focus not on those two issues, but on the fact that veterans with noise-induced hearing loss are unique in being ineligible for a lump-sum gratuity. Before 1993, veterans with more than 20 per cent. disablement received a pension, while those with less than 20 per cent. disablement received a lump-sum gratuity. A veteran with 50 per cent. noise-induced hearing loss would get a pension, while one with, say, 40 to 50 per cent. hearing loss would get a gratuity. After 1993, veterans continued to receive a lump-sum gratuity for every condition except noise-induced sensorineural hearing loss. That is because, in 1992, the then Government decided to introduce a 20 per cent. cut-off, below which an award would not be made for noise-induced sensorineural hearing loss.
In the last debate on this issue, in 1999, the then Under-Secretary of State for Social Security, my hon. Friend the Member for City of York (Hugh Bayley), said that the 20 per cent. cut-off was introduced as
“part of a package that included extra cash for war pensioners.”—[Official Report, 3 March 1999; Vol. 326, c. 1044.]
That is fine, but while some war pensioners benefited, the introduction of the cut-off meant that many thousands of veterans with noise-induced sensorineural hearing loss as a result of service were, uniquely, excluded from any compensation or recognition.
The basis of the decision to introduce a 20 per cent. cut-off was revealed in an answer to the Select Committee on Social Security in 1999. There was a peak of claims in the early 1990s, when ex-service organisations were quite properly alerting people to the war pensions scheme, and research conducted by officials at the war pensions directorate revealed that claims
“were in the main coming from the geographical areas of the country which were sites of heavy industry at the time. They seemed particularly to be involving people at or about retirement age who, in a large part but not, of course, exclusively, had done two years’ National Service and then spent quite a long time in industry.”
One of the main reasons for the cut-off, therefore, was a deliberate attempt to ensure that what has been described as a low degree of hearing loss fell below the compensation threshold—that is, to exclude those who were judged to be less deserving of a lump-sum gratuity.
Let us look at the effect of the 20 per cent. cut-off on deafened veterans by taking a typical example. In 1999, Mr. Roper received a letter from the War Pensions Agency informing him that he had 6 to 14 per cent. noise-induced hearing loss attributable to service, but that he could not be paid for it because the assessment was less than 20 per cent. Thousands of veterans have received such letters since 1993. However, had Mr. Roper instead suffered damage to his sight, for example, he would have received a lump-sum gratuity in recognition of his condition. Currently, the compensation for 6 to 14 per cent. sight loss is slightly more than £4,750.
In other words, veterans are told first that they have a hearing loss attributable to service, but then that it is not significant enough to merit compensation. That is incredibly insulting to those who struggle daily with the effects of hearing loss. It is not surprising that Royal National Institute for Deaf People, along with the British Legion and other veterans organisations, has received many letters from veterans complaining about the unfair cut-off.
Unfortunately, there is still a pronounced tendency in our society to underestimate the effects of hearing loss. Compared with other disabilities, an inability to hear is commonly regarded by others as a minor complaint. It can be a source of humour and teasing. There may be an insinuation that the person is stupid or incapable, or perhaps difficult or grumpy. As a result, the barriers that people who are deaf or hard of hearing face are frequently dismissed as insignificant. However, as anyone with a hearing impairment knows, loss of hearing can be incredibly frustrating.
That misunderstanding of hearing loss continues to inform Government policy, and deaf and hard of hearing people continue to have the effects of their disability underestimated. In the last debate about veterans with noise-induced hearing loss, the then Under-Secretary of State for Social Security described 50 dB hearing loss as
“the point at which a person starts to have trouble following conversation in a noisy environment.”—[Official Report, 3 March 1999; Vol. 326, c. 1044.]
As the vast majority of audiologists know, that is not so. A person with 50 dB hearing loss is likely to have considerable difficulty following a conversation in ideal listening conditions, let alone in noise. Although the Under-Secretary’s comments might have been made in error, they are nevertheless typical of the way in which hearing loss is misunderstood and dismissed as insignificant. The treatment of deafened veterans by the War Pensions Scheme seems to be based on such a flawed understanding.
I congratulate the hon. Gentleman on securing the debate. The handling of this issue is an insult to people who have served in the armed forces, and that includes not only those who served their country under national service, as the hon. Gentleman did, but regulars. I came through the Army in the ’70s and ’80s, and no ear defenders were available to us. Indeed, when we went on active service or on live-firing ranges, they were the last thing in the world that we would have been given, because those in charge were worried about command and control. The insult to veterans will get worse and worse. If the Minister does not listen today, how will we take the issue forward?
Indeed, I thank the hon. Gentleman for his support. He shares my experience entirely and I hope that I will continue to have his support.
The RNID has conducted research showing the effects of noise-induced hearing loss on veterans’ lives. Such people have great difficulty following conversation in normal social settings. Many have been involved in local community work for many years, but they have had to give it up because of their hearing loss. Some also speak of the effects of their hearing loss on their relationship with their partner, while others say that they have difficulty hearing their grandchildren, which is a source of great distress. That is what hearing loss means in practice: the local community, the family and the veteran’s mental well-being are at stake.
Of course, people acquire hearing loss as a result of the ageing process, and it is not unfair to ask whether they would have become deaf or hard of hearing anyway. We cannot compensate people for hearing loss that is not attributable to their service, but a 50 dB hearing loss is a greater level of deafness than most people ever experience through ageing alone. Given that the majority of deafened veterans who are being turned down are told that their hearing loss is attributable to service, the 20 per cent. cut-off is unjustifiable and totally unfair.
We have an obligation to all those who suffer from a condition that is attributable to service and a moral duty to give them the best possible aftercare. Servicemen and women put themselves at the service of the state daily, and they deserve to know that the sacrifices that they make for their country will not be forgotten. No veteran should be sidelined, and it is not acceptable for us to ignore veterans with noise-induced hearing loss attributable to service. A petition of 18,000 signatures circulated by the Royal National Institute for Deaf People suggests that the public strongly agree.
In comparison, other countries treat veterans with noise-induced hearing loss more sympathetically. In the Republic of Ireland the cut-off is not 50 dB but 20 dB. In the United States, Canada and South Africa it is 25 dB. Certainly we cannot feel proud of the way in which we treat veterans with noise-induced hearing loss in this country.
I know that the RNID has been in discussion with officials at the Ministry of Defence about the feasibility of making sure that the sacrifices made by deafened veterans are recognised. I am sure that there will be a number of difficulties. It could, for example, prove to be very complicated to make retrospective payments, however desirable that might be, to say nothing of the expense. But whatever the difficulties, they should not be a cause of inaction. There are a number of possibilities that could be considered, such as the lowering of the cut-off point to a more acceptable level.
An alternative response would be to look at the priority treatment that veterans receive. There appears to be a degree of uncertainty as to how that works in practice. Recent written answers and past guidance suggest that priority treatment relates to examination or treatment relating to pensioned disablement. Anecdotal evidence suggests that many, if not most, health service clinicians believe that veterans must have a pension to get access to priority treatment. However, it appears that priority treatment should in fact be much more widely available.
I have seen recent correspondence from the Minister giving a definition of priority treatment quite different from the current guidance. In fact, in a letter to Mark Morris of the RNID the Minister stated:
“Priority treatment applies to all disablements that have been found to be due to Service, so all war veterans who suffered noise-induced hearing loss as a result of service, irrespective of being in receipt of a war pension, are able to access priority treatment from the NHS.”
That is most welcome clarification. However, that is not how priority treatment is implemented on the ground. The confusion on the issue needs to come to an end. It is vital to issue clear guidance across the NHS as a matter of priority. It is especially important that every audiology department should fully understand and implement the correct policy on priority treatment. No one should have to wait months, let alone years, for a digital hearing aid, but if there is one group of people who, as a matter of urgency, should be fast-tracked, it is surely those who have suffered damage to their hearing because of military service.
The need for clarification about priority treatment is especially important because, as many hon. Members will know, there are pressing problems with the delivery of digital hearing aids, with average waiting lists of more than two years in parts of the country. Yet digital hearing aids, which are now available on the NHS, are a significant technological improvement, and the vast majority of older people with a hearing loss find them of great benefit. I can vouch for that myself. A suitable course of action might therefore be to inject a sum of money into the NHS from the war pensions scheme to ensure high-quality treatment for veterans with a hearing loss attributable to service. That would clearly be a token payment, but it would go some way towards recognising the situation faced by the veterans.
At present we accept that we exclude from any compensation a person who, solely as a result of their military service, no longer has the ability to enjoy a conversation in a typically noisy pub or a restaurant; or the chance to go to the cinema or theatre and actually enjoy or appreciate the performance; or even the ability to go to church and fully understand the service. All those opportunities have been taken away from thousands of men and women, solely because of their military service for this country. In compensation for such a serious reduction in the quality of life caused by their service to the country, they have received absolutely nothing. Can anyone seriously justify that and say that it is right?
In conclusion, I urge the Government to find a way to address the harsh consequences of the 20 per cent. cut-off as soon as possible and to ensure that the sacrifices made by veterans with noise-induced hearing loss attributable to service are recognised. Singling out that group of veterans in a way that deprives them of compensation is illogical, arbitrary and unfair, and has led to thousands of veterans feeling that their daily struggles are considered insignificant. Our veterans and the veterans of the future deserve better.
It is a pleasure to serve under your chairmanship again, Miss Begg. I thank my neighbour, my hon. Friend the Member for Knowsley, South (Mr. O’Hara), for raising this topic, and congratulate him on having, as usual, set out the issues clearly and concisely. I know that he is a solid campaigner on such issues and takes great interest in health matters generally. I congratulate him on securing the debate and appreciate the opportunity to respond to his points and to speak about the outstanding contribution of those who have served and continue to serve in the armed forces.
The Government recognise the special commitment that service personnel make and the scale of their contribution. Our veterans have played a vital role in our defence effort across the decades, and I take this opportunity to pay tribute to them for everything that they have done in the service of their country. As I speak, our servicemen and women are doing a fantastic job, sometimes in dangerous and difficult environments. I have met them on operations in Iraq and Afghanistan. Their professionalism and selflessness never fail to impress. We ask a lot of our service personnel, and that is why their welfare is a priority and why we are committed to ensuring that they get the best possible support. We are determined to ensure that their commitment and the unique nature of the role of our armed forces are properly reflected in the payments that we make in compensation for injury caused by service.
It may help if I start by setting the context. We are debating sensorineural hearing loss resulting from chronic exposure to noise. For clarity, I must stress that the 50 dB compensation threshold applies only to noise-induced sensorineural hearing loss. It does not apply to other forms of hearing loss or injury, such as that caused by blast; different provision is made for compensating such injury. Under the war pensions scheme, injury due to blast is compensated down to 30 decibels hearing loss and in the armed forces compensation scheme a separate tariff item is included for blast injury. The civilian equivalent of noise-induced hearing loss is industrial deafness, traditionally associated with employment in noisy working environments such as shipyards and mines. The risks of prolonged exposure to noise have long been recognised and guarded against.
The Ministry of Defence takes very seriously its responsibilities in ensuring the health and safety of our service personnel. Hearing loss caused by chronic exposure to noise in service is increasingly an historical phenomenon; since the mid-1960s, precautions and equipment have been used to protect the hearing of service personnel from noise relating to service, including that arising in combat. I can confirm that the Noise at Work Regulations 1989 apply throughout all parts of the MOD as far as is reasonably practical. That is subject to the general agreement between the MOD and the Health and Safety Executive on observance and audit of health and safety legislation in the MOD. Hearing protection is always provided—indeed, it is made very clear to all personnel that it is an essential part of their equipment, which must be used at all times when noise exposure reaches the level at which protection may be needed. I must stress, however, that we are not complacent about that very important issue. Our policy is kept under review at all times.
The present approach to compensating noise-induced sensorineural hearing loss under the war pensions scheme was introduced in January 1993, as my hon. Friend said. Following the change, compensation was awarded for such hearing loss only if it was 50 dB or more in both ears, averaged over the frequencies of 1, 2 and 3 kHz. In most cases that meant that a lump sum gratuity was no longer paid. That brought the approach in war pensions into line with that in the civilian industrial injuries scheme, in which occupational deafness had never been recognised where hearing loss was below that threshold.
The introduction of the compensation threshold for noise-induced hearing loss was not an isolated change, but part of a package of amendments that focused benefits on the more severely disabled. In particular, rank differentials were removed for the scale of war disablement pensions and rates were increased. As a result, pensions were increased by up to £5 a week above inflation. Increases were focused on the more severely disabled, with the most severely disabled other ranks gaining most. The increase benefited all those receiving a pension at the time and, indeed, all those who have claimed since.
The threshold has been confirmed in recent years by several reviews carried out by independent audiological experts, and it is common to the war pensions scheme, the armed forces compensation scheme and the equivalent civilian industrial injuries disablement scheme. A 2002 report on occupational deafness by the Industrial Injuries Advisory Council confirmed that the compensation threshold of a 50 dB average over 1, 2 and 3 kHz remained appropriate. The IIAC is a non-governmental body that advises the Secretary of State for Work and Pensions on the industrial injuries scheme.
Our medical policy advisers keep the scientific and medical literature about noise-induced sensorineural hearing loss under regular scrutiny and correspond with experts around the world who are working on the topic of noise-induced deafness. To date, we are not aware of any new scientific evidence that would require a change in our approach to assessment, but we are always open to new evidence of an appropriate standard on any aspect of pensions and compensation.
The threshold has been carried forward into the new armed forces compensation scheme, which applies to injuries and illnesses caused by service on or after 6 April 2005. It, too, focuses awards on the more severely disabled, and bilateral hearing loss of less than 50 dB is not compensated. Compensation for hearing loss due to service is based on the degree of loss at service termination, because it is accepted scientifically that any hearing loss arising after that date will not be caused by exposure to noise in service. The reason for that approach is that a war disablement pension may be paid only for disablement that is due to service; it cannot be paid for hearing loss that is due to other causes—for example, ageing. It is only the causal link with service that justifies the generous provisions of the scheme, so to remove it to make compensation available for disablement that is due not to service but to other factors such as age would undermine that basic principle.
My hon. Friend has mentioned the different approach in other countries to the level of the threshold for compensation, and I should like to make two points about that. First, there is wide variation in the hearing ability of normal people. Secondly, there is no consensus among schemes on the appropriate compensation threshold. Most schemes have a low threshold offset for other causes of hearing loss, including age—in other words, they make a deduction from the overall level of hearing loss present at point of measurement to take account of loss caused by other factors.
The war pensions scheme does not offset, because of the difficulty of accurately making such adjustments in any particular case. Instead, we accept and assess all hearing loss present at the point at which the individual is removed from any possible service noise injury—that is, at service termination. Our assessments may therefore contain a significant proportion of loss due to other causes, including ageing up to the point of discharge.
My hon. Friend clearly recognised that there would be an issue of cost were we to make any sort of change to the threshold and, in effect, restore the payment of gratuities for noise-induced hearing loss of less than 50 dB. The reintroduction of the payment of gratuities for hearing loss of less than 50 dB would come at high cost. The cost would require us to consider making balancing changes, for example, by reviewing the 1993 package.
My hon. Friend points to an alternative route: ensuring that ex-servicepeople who have hearing loss caused by service receive priority access to up-to-date hearing aids. Hon. Members may know that priority treatment refers to the long-standing arrangement whereby war pensioners are entitled to priority from the health services for treatment of injury or illness caused by service, subject only to overriding clinical priority, as decided by the clinician in charge.
I am happy to confirm that priority treatment applies to all disablements that have been found to be due to service, irrespective of whether they result in a pension. For clarity, three groups are eligible for priority treatment from the health services for a service-related condition: those who receive a continuing war pension; those who receive a one-off gratuity; and those whose condition has been found to be caused by service, but has not attracted an award
My hon. Friend raised the issue of funding such arrangements, so it may help if I were to explain that payments were once made under the war pension scheme for privately supplied hearing aids for people with hearing loss due to service. Following changes to health service policy and practice in the 1990s, payment from war pensions was no longer appropriate and such payments ceased. At the same time, funds relating to hearing aids were transferred from war pensions to the health service.
I reassure my hon. Friend that officials are in continuing discussions with the UK health departments regarding the awareness of priority treatment among health professionals. I have also met the Secretary of State for Health and the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), to discuss priority treatment. A lot of work is clearly being done on this issue. Later this year, the health departments will distribute reminders to the chief executives of trusts requiring them to ensure that general practitioners and hospital clinicians are aware of all those veterans who are eligible for priority treatment, including the group that we have been discussing.
I thank my hon. Friend for raising this important issue. I hope that I have been able to provide answers to some of the points that he made.
Question put and agreed to.
Adjourned accordingly at five minutes to Two o’clock.