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The Duke of Montrose: My Lords, perhaps the Minister could answer the first part of the question of my noble friend Lady Byford. Do the Government have any view on whether these regulations will be brought in on a parish, district or county basis? How will they distinguish which areas are considered to be waterlogged? I gather that at one time these regulations were interpreted as applying only in winter. Does the Minister envisage that they could apply all year round?
Lord Whitty: My Lords, there is no seasonal distinction. Clearly, it rains more in some seasons and in some parts of the country than in others. The regulations are national in the sense that they are English. There are Scottish, Welsh and Northern Irish regulations which are broadly similar. In fact, the English ones probably have rather more exemptions than the others, possibly because it rains more in those countries.
The regulations will be applied by local officers as part of their general approach as to whether the farmer is keeping the land in good agricultural and environmental condition, which is the basic European standard. It will be subject to information on rainfall, but based primarily on the condition of the soil.
The Countess of Mar: My Lords, the Minister did not answer the question of the noble Baroness, Lady Byford, about different fields having different conditions. On our farm we have a field which we call "hell-hole" because most of the year it is such a swine to get anything on or off it. It is wet and soggy at one end and dry and dusty at the top end. How will the legislation be policed? What penalties will there be for farmers who do not obey the rules?
Lord Whitty: My Lords, as part of the assessment of whether good agricultural and environmental standards have been met, local officers will need to
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take into account the topography, the nature of the soil and what the farmer is doing in general to keep the land in good condition. As I say, they will be expert people dealing with such areas.
As far as concerns sanctions, I think that the House should look at the matter the other way around. This is a very basic condition for the payment of a substantial amount of money to farmers. The total cost of compliance with all matters, including this, amounts to around 1 to 2 per cent of the total benefit of the subsidy. That seems a not unreasonable condition. Part of that compliance must include keeping the soil in good condition and therefore avoiding unnecessary machinery going into waterlogged fields.
Lord Mackie of Benshie: My Lords—
Earl Ferrers: My Lords, is this not bureaucracy gone mad? What makes the noble Lord, Lord Whitty, think that the officials of the Rural Payments Agency will know more about the mechanical conditions of the soil than the farmer who actually runs the farm?
Lord Whitty: My Lords, it is not bureaucracy gone mad; it is ensuring that the farmer operates in a way that gets the support of society as a whole and does the basic job of keeping the land in good condition. Regrettably, it is true that on occasions some farmers have not taken very good care of their soil. Therefore, the regulations should at least give them a nudge that if they continue operating in a way which destroys the quality of the soil, the sanction is that their payment could be docked. But that is the ultimate sanction. Primarily, this provision ensures good husbandry, good condition of the soil and therefore better farming and better landscape.
Hearing Aids
Baroness Howe of Idlicote asked Her Majesty's Government:
What plans they have to extend the public/private partnership between the National Health Service and private hearing aid dispensers so that more private sector companies can help audiology departments to reduce waiting times for digital hearing aids.
The Parliamentary Under-Secretary of State, Department of Health (Lord Warner): My Lords, the existing contract with two private companies was established following a public tendering process and runs until October 2005, at which point it will be open to review. The current public/private partnership is proving very successful, with more than 12,000 patients already off the NHS waiting list and more than 50,000 set to benefit by April 2006. Both companies have the capacity
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to see more patients if local NHS trusts choose to commission additional services, although there are currently no plans to extend the partnership.
Baroness Howe of Idlicote: My Lords, I thank the Minister for that reply and, in passing, congratulate the Government and the Royal National Institute for Deaf People on the tremendous efforts that they have already made to get digital hearing aids to NHS patients. However, is not the Minister a little disturbed by the recent survey by the British Society of Hearing Aid Audiologists, which reports an average delay of 46 weeks between a GP referral and the actual fitting of a hearing aid? In some parts of the country, the delay is as long as four years.
As we now know from the RNID that the quality of life of 3 million to 4 million people could be considerably enhanced by digital hearing aids—I believe that there have been signs of up to 41 per cent improving in hearing—is there not a strong case for involving many more than the two private companies which employ registered hearing aid dispensers to speed up the process for NHS patients?
Lord Warner: My Lords, I do not think that that is necessary. As I said in my Answer, the companies have the capacity to see more patients if local NHS trusts choose to commission additional services. So there is no lack of capacity in the system to supply. This Government were the first to address the fact that NHS audiology was suffering from outdated technology and long waiting times. We are to some extent the victims of our own success by introducing digital hearing aids, which were never previously available.
Baroness Greengross: My Lords, will the Government monitor waiting times after next year? After all, older people, who form the majority of hearing aid users, do not have time to wait for up to four years. It would be very good if we knew how that monitoring is to be carried out.
Lord Warner: My Lords, we intend, as we do across the NHS, to return that money to local PCTs. It will then be for NHS PCTs, which, after all, are now responsible for about 80 per cent of expenditure on the NHS, to ensure that their services meet the needs of their communities.
Lord Ashley of Stoke: My Lords, I declare an interest as the president of the RNID. Does not my noble friend agree that the scheme compiled by the RNID and his department is a tremendous success? So far, it has given 250,000 deaf and hard of hearing people a digital hearing aid free, whereas a short while ago they were extremely expensive. That is a great accomplishment but, as we have already heard, there are delays all over the country, bottlenecks and long queues of people. In my view, the only way to resolve that problem is for the Government to make the
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scheme a much higher priority, allocate more resources and more skilled audiologists. Can my noble friend help on that?
Lord Warner: My Lords, I am grateful for my noble friend's remarks. He is quite right: the scheme has been a huge success, which is down to the work that we have accomplished in partnership with the RNID, to which I pay great tribute, and is as a result of the extra £125 million that we have invested in the area since the modernising hearing aid service started in September 2000. We are working with the RNID and others to expand NHS audiology posts, of which we acknowledge that we need more. However, as I said, it is down to PCTs, which are supposed to consider the needs of their local communities, to determine their priorities and to put resources into those which meet the needs of their local communities.
Baroness Neuberger: My Lords, given that the Minister has just said that it is down to local PCTs, can he say how many PCTs have taken advantage of the PPP so far; how many more patients have been treated as a result; and, indeed—although this may be a guess—how many PCTs have indicated their desire to participate in the PPP in future and the extent to which the Government may encourage PCTs to do so?
Lord Warner: My Lords, I can answer the first question: the latest figure that I have is that about 75 NHS trusts have committed themselves to participate in the public/private partnership, which represents almost 50 per cent of the NHS audiology departments in England. I do not have information on how many more have expressed an interest or are moving towards participating in the partnership, but we are putting a lot more money into the area. As my noble friend Lord Ashley said, about 250,000 people have already benefited from the modernising hearing aid service with new digital hearing aids.
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