Select Committee on Health Written Evidence

Evidence submitted by the Royal National Institute for the Deaf (WP 18)


  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.

    —  An ageing population

  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:

    —  Financial Constraints

  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.


  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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