Evidence submitted by the Royal National
Institute for the Deaf (WP 18)
Introduction
RNID is the largest charity representing the
nine million deaf and hard of hearing people in the UK. Around
six million people in UK have a hearing loss that could benefit
from some degree of amplification of whom only two million currently
have a hearing aid.
Audiology services in England have changed considerably
over the last five years from being services that had developed
little from the 1970's and lacked modern technology to becoming
fully modernised as a result of the Modernising Hearing Aid Services
(MHAS) programme. The RNID managed the MHAS project, funded by
the Department of Health, which has enabled audiology services
to offer high quality digital hearing aids, programmed to meet
each person's needs according to nationally agreed protocols.
Similar modernisation programmes have taken place in the other
countries of the UK. The Newborn Hearing Screening Programme (NHSP)
was another recent initiative that also impacted on audiology
services.
The MHAS programme was extremely successful
with all 164 Trusts now enjoying modernised hearing aid services.
Medical Research Council (MRC) evaluation of the Programme has
demonstrated that people have reported a significant improvement
in their quality of life as a direct result of receiving digital
hearing aids free of charge from the NHS.
However the success of this and other initiatives
has meant that demand and expectations on services have also increased.
There is a historic shortage of audiologists and this coupled
with a higher demand has led to increased waiting times in many
areas, particularly in adults' services. The NHS has struggled
to provide the capacity necessary to meet the demand from those
who require hearing care.
These issues make it imperative that audiology
departments have the appropriate skill mix and staffing levels
to deal with the increased demand and expectations on services.
The work towards 18 week targets from referral
to treatment has highlighted the need for the Department of Health
to plan the Healthcare Scientists Workforce as a matter of urgency.
What workforce planning has currently been undertaken?
The British Academy of Audiology (BAA), is the
largest UK Audiology organisation representing the views of Audiologists.
The BAA have looked at the "future of the audiology workforce"
and written a comprehensive paper documenting their proposals
(Sutton, 2005). According to the BAA's report much of the work
that is currently carried out in Audiology departments is fairly
routine such as simple clinical tasks and administration. High-level
audiology staff carry out much of this work, when it could be
done by assistants, which would also be more cost effective.
The BAA worked with the Department of Health
to develop National Occupational Standards and the healthcare
scientists' career pathway framework, and is currently looking
at developing a foundation degree for an associate position.
There are estimated to be around 2,000 WTE qualified
audiologists working in the NHS throughout the UK currently.
A recent NHS workforce project has suggested
an additional 1,700 qualified audiologists are required to cope
with current pressure. This could take between 10 and 15 years
to realise under the current training programmes.
There are currently around 350 assistant audiologists
and BAA suggests that the NHS needs a similar number of the new
associate grade staff. There is an urgent need for more training
for these positions.
A BSc (Hons) Audiology was introduced in 2002,
which aims to partially address the need for more highly trained
audiologists. The degree is now available in nine Universities
in the UK. As the degree is a four-year full time course, with
the first cohort of students graduating June 2006, it will be
a number of years before these graduates really do impact on the
numbers of audiologists.
Without the right workforce, audiology will
not be able to deliver effective and efficient services to patients
and waiting times—currently around a year in many areas—will
continue to increase. There is a consensus that the audiology
workforce needs to have highly trained staff, with appropriate
skills and be flexible.
In considering future demand, how should the effects
of the following be taken into account?
— Recent policy announcements, including
commissioning a patient-led NHS.
Provision of audiology services may change in
the future—most of the service can be provided in a community
setting. There may be an increase in non NHS provision. The current
system requires different training and accreditation for the individual
depending on whether they are working in the NHS or private sector.
There is a need for unified training and qualifications.
The future state registration should include
both the public and private sectors. ie one body regulating professionals
employed in the public and private sectors. This will help to
assure quality for service users while also giving a more flexible
workforce.
Age related hearing loss is the most common
cause of deafness. As the population ages this will have a massive
impact on audiology services as a higher number of people will
start to lose their hearing in later life. Currently, more than
half of people over the age of 60 have lost some hearing. The
Medical Research Council estimates that the number of deaf and
hard of hearing people in the UK—already exceeding nine
million—is set to increase by 14% every 10 years. This means
that in 30 years time (by the year 2036) there will be more than
13 million deaf and hard of hearing people in the UK.
The government's agenda is to encourage older
people to lead more healthy, independent, active lives—participating
more fully in their families and communities and even working
longer. However, for this to happen, older people losing their
hearing must have ready access to the technology and services
that can reconnect them to society. It is therefore essential
that there are high quality, easily accessible hearing aid services.
— The increasing use of private
providers of services
The private sector is already helping with delivering
hearing aids to NHS patients through the Public Private Partnership
(PPP). However, there are not enough new people training/qualifying,
as Hearing Aid Dispensers currently to enable the private sector
to meet NHS demands. Equally whatever the potential for diversification
of provider organisations and better use of skill mix, there are
certain tasks within audiology & hearing aid services that
can only be undertaken by staff who are fully qualified in audiology
and trained to follow nationally agreed protocols. This is essential
to ensure quality and equity in outcomes for service users. Diversification
of provider organisations will not overcome the fact that there
exists at present a limited pool of qualified audiology staff
in all sectors, giving inadequate capacity to meet demand. There
has already been substantial international recruitment but this
has not solved the problem—and in order to ensure quality
and equity for service users such recruits need specific training
in standard procedures and protocols in the UK.
How will the ability to meet demands be affected
by:
It is important that all the substantial investments
in audiology over recent years are maintained and this must include
investing in staffing and the workforce. The momentum must not
be lost as there is a risk that access to the modernised services
become restricted due to ever increasing waiting times and/or
narrower eligibility criteria. The Department of Health released
funding for 2005-06 to support modernisation of audiology, but
there is a danger that this funding (approx £38 million)
may be cut in 2006-07 for both staffing and hearing aids. It is
important that this does not happen and that commissioners are
encouraged to fund audiology services.
To what extent can and should the demand be met,
for both clinical and managerial staff, by:
— Changing the roles and improving
the skills of existing staff
As outlined above, it is necessary to have a
workforce with the right skill mix in audiology departments. The
BAA is working towards developing more formal requirements for
assistant and associate posts with the Department for Health—eg
the foundation degree for Associate Audiologists.
— The recruitment of new staff in England
The BSc will help with the recruitment of new
staff in England. However, the profession of audiology is not
currently promoted effectively, there is little information available
to potential employees, and what information is available is difficult
to find.
— International recruitment
There are currently many locums from other countries
working in the NHS. While this is helpful in the short term, it
is expensive and doesn't address underlying capacity issues. It
can also create quality assurance problems because international
recruits need additional training in UK procedures and protocols.
How should planning be undertaken?
— To what extent should it be centralised
or decentralised?
Decentralised workforce planning is essential
to ensure services can meet local needs. However, it is vital
also that centralised planning occurs to ensure there is an adequate
pool of appropriately qualified staff across the UK, and that
the necessary training is in place. There also needs to be effective
information flows between central and Strategic Health Authority
planners.
RECOMMENDATIONS
Core funding of audiology services must be continued
by ensuring that £38 million goes through to local audiology
services as in 2005-06 to support modernisation.
Priority must be given to introducing formal
training routes for associate audiologists to ensure that there
is the correct skill mix in departments.
The BSc in Audiology should be extended to additional
HEIs to ensure that the audiology workforce can meet capacity.
Angela King
Senior Audiologist Specialist, RNID
March 2006
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