POP into the audiology clinic at York District Hospital and most days you will find a scene of orderly chaos. Chairs line both sides of the dingy corridor - the clinic's only 'waiting room'. The mainly elderly patients could be waiting to see a consultant, an audiologist - or simply Sue Smith, the friendly nurse who runs the clinic's free hearing aid repair service and who has hearing problems herself.

Hearing tests are carried out in two specially sound-sealed rooms - rooms oddly smaller inside than outside because the thick layers of sound-proofing were only added after they were built.

Out in the corridor, a basket of soft toys is an attempt to make the clinic more child-friendly - but, in the stark corridor, it manages only to look sad.

These are precisely the kind of cramped, outdated conditions that, despite the best efforts of staff, help to give the NHS a bad name.

The good news is, all this is about to change.

Funding is in place for an £850,000 revamp of the audiology clinic and the Ear, Nose and Throat unit it shares a cramped corridor with.

By the middle of next year both units should have moved into new premises elsewhere in the hospital. The audiology clinic will get four state-of-the-art soundproofed testing rooms, a paediatric room, a balance assessment room, a new hearing aid repair room and two fitting rooms. There will even be a waiting area and children's play area.

Just what the doctor ordered, in fact.

What the revamp won't mean, however, is digital hearing aids being prescribed on the NHS to the clinic's 20,000 patients from York and across North Yorkshire.

For some, that's a sore point.

A few years ago, the Government offered hospitals the chance to bid to become one of 20 pilot centres prescribing digital hearing aids. York District Hospital, like many others, jumped at the chance and applied.

Its bid failed - no criticism there, because most hospitals were unlucky.

This year, however, the Government invited a second wave of applications. This time the YDH didn't even apply.

With digital hearing aids - prohibitively expensive for many if bought privately - generally perceived as being much better than the analogue ones now available on the NHS, it's a failure that has ruffled more than a few feathers - York MP Hugh Bayley's among them. He admits he was 'very concerned' when he learned the hospital was not preparing a bid this time. "Digital hearing aids hugely improve the quality of life of some deaf people," he says.

Retired Askham Grange prison officer Pat Rhodes agrees.

She was fitted for an analogue aid at the audiology clinic in 1988 after her hearing became a problem at work. But after just a couple of years she decided to go private and pay for a digital aid.

Her analogue aid, she says, was uncomfortable and caused problems with background noise. Her digital aid was a revelation: smaller, more comfortable and with much background noise filtered out. "I couldn't believe it. Everything was so clear!" she says.

Head of audiology Richard Addis agrees that in many cases digital hearing aids are better. He likens the difference to that between cassettes and CDs. "We all changed from vinyl to cassettes and thought they were great," he says. "But there was a lot of hissing and background noise. Then a few years later along came CDs and we thought they were wonderful. There was no background noise."

So, if they are so much better, why did the hospital pass up the chance to be able to prescribe them to local patients?

The answer reveals much about the strains on today's NHS - and the sometimes unrealistic expectations of patients.

Firstly, says Richard, to have become one of the pilot sites prescribing digital hearing aids would have put a huge drain on the audiology clinic's resources.

Digital hearing aids cost three or four times as much as analogue ones. Neil Wilson, the York District Hospital administrator responsible for head and neck services, says Government funding promised for pilot sites would have met only 75 per cent of the extra cost for the first year - leaving hospitals to pick up the tab thereafter. That extra cost might have meant other aspects of the clinic's work having to be pared down.

Then there would have been the extra demands on staff. Digital hearing aids take much longer to fit properly, says Richard. They require a number of repeat visits.

"In the time it would take me to properly fit one digital aid, I could fit five analogue aids," he says. The effect on waiting lists need only be imagined.

Then there are the misconceptions. "Many people hear the word digital and think the aid is going to be very small," Richard says. "That's not necessarily going to be the case." In fact, he says, three of the four digital aids being considered by pilot hospitals are worn outside the ear, in the same way as current NHS hearing aids.

Digital aids anyway are simply not going to be the answer to everybody's hearing problems, says Richard. While for some they may make a real difference, for others there will be little or no benefit.

Finally, even if the hospital were to become a digital centre, it would not mean all the clinic's 20,000 patients being automatically upgraded to digital.

There would be lengthy waiting lists and many people would not be eligible at all. "Even when we are in a position to start issuing them, we as a department are going to have to sort out criteria," says Richard. "We're going to disappoint 90 per cent of patients."

That doesn't mean the digital revolution won't come to York.

The hospital hopes if bids are invited for a third round of pilot centres, it will be in a better position to apply. "It's something we would be looking to offer in future," says Richard. "But I think it is going to be five to ten years before all patients on the NHS can try digital aids."

Until then, unless you go private, you will have to make do with analogue. You could do worse says Paul O'Connell, a volunteer with the Resource Centre for Deafened People in York who wears an NHS analogue aid fitted by the audiology clinic.

NHS hearing aids, he insists, can actually be better than some of the small aids people buy for cosmetic reasons that fit into the ear. And he's yet to be convinced digital aids are as good at eliminating background noise as they are cracked up to be.

He has no doubts, however, about the quality of care staff at the audiology clinic are providing. "They do a marvellous job," he says.

- The Resource Centre for Deafened People at 61 Bootham, York, offers advice and information about hearing aids. Drop in on a Thursday, or call 01904 626583 for an appointment

Updated: 10:46 Wednesday, April 24, 2002