Conclusions and recommendations
1. Audiology
services improved greatly as a result of the introduction of digital
hearing aids and the MHAS programme. However, this led to a surge
in demand, not only from new patients but also from those who
wished to switch from analogue aids. This increased waiting times
which the NHS surprisingly did not anticipate. (Paragraph 41)
2. Details about the
extent of waiting times are unclear because of inadequate data
recording and collection. We recommend that comprehensive data
be collected and published on all patients waiting for audiology
services from GP referral to treatment. The information we have
received indicates that some individual trusts have no waiting
list while others have waits of over two years. (Paragraph 42)
3. Some PCTs have
failed to give audiology services the priority they deserve. The
Minister admitted that audiology services had not been seen as
a priority, but this still seems to be the case. The publication
of the new audiology framework was delayed for almost one year.
Its publication eventually coincided almost exactly with the Committee's
inquiry. The framework adds little that is new. Already some of
the targets in the framework, such as publication of the adult
hearing loss model care pathway by March 2007, have not been met.
(Paragraph 57)
4. We note the Minister's
determination to meet the existing target of providing diagnostic
tests for audiology within six weeks by March 2008. This will
be difficult. The first stage of this target—for all patients
to receive diagnostic tests within 13 weeks by March 2007—has
already been missed. The Minister told us that "quite a number
of people could have their hearing aid fitted literally on the
same day as the assessment", presumably through the use of
'open-fit' technology. Whether this can be adopted widely is being
investigated and must be confirmed. (Paragraph 58)
5. The exclusion of
audiology services from the 18-week target means that patients
with hearing problems are waiting for over two years to receive
treatment in some areas. This is particularly unacceptable since
the hearing aids are so effective. The exclusion has led GPs to
have their patients seen quicker by referring them to ENT departments.
It is ridiculous that this loophole exists since it can be so
easily exploited and increases costs and waiting times for ENT
outpatient appointments. Waiting times for all audiology patients
will remain long if audiology remains outside the 18-week target.
It would be difficult to do it immediately, but we recommend that
the Department of Health include audiology services within the
18-week target at an early date. Meeting the 18-week target should
be possible once the six week target for diagnostic tests for
audiology has been achieved. (Paragraph 59)
6. We recommend that
the Department undertake a thorough examination of the medium-
and long-term demand for digital hearing aids. (Paragraph 91)
7. We recommend that
audiology departments review the way in which they provide services
to patients, identifying the skill mix and the levels of training
or experience necessary. Their reviews should also examine the
possibility of operating flexible opening hours, telephone follow-up,
home visits, the use of Choose and Book and cross-boundary working
to increase the numbers of patients seen. The cost of hearing
aids could be reduced by bulk purchasing. (Paragraph 93)
8. We received evidence
about the extent of graduate unemployment. We recommend that the
Department examine the situation of recent audiology graduates.
(Paragraph 94)
9. Value for money
assessment must be carried out. This will be difficult without
a tariff. We note that the Department will consider this in 2007.
We recommend that the Department produce a national tariff for
audiology at an early date. (Paragraph 95)
10. The contracts
negotiated with the private sector must ensure that patients receive
adequate care and follow-up. Services must be monitored and the
quality of care must be assessed on the same basis as the quality
of care is assessed in the NHS. (Paragraph 96)
11. We are concerned
that older and sometimes vulnerable people might be encouraged
to buy more expensive hearing devices than necessary. The Department
must ensure that encouragement to patients to 'trade up' to a
more expensive hearing aid is limited. (Paragraph 97)
12. The Department
must ensure that the involvement of the private sector does not
undermine the NHS's capacity to provide expert audiology services.
It must assess the effects of private sector activity on NHS capacity
and levels of expertise within audiology departments. We were
encouraged that the Department appears to be listening to local
commissioners about whether private sector involvement is needed.
(Paragraph 98)
13. We recommend that
private sector contracts be relatively short-term in the first
instance but extendable subject to companies achieving and maintaining
high standards of treatment and care. Future contracts should
depend upon demand remaining high, as the private sector maintains
will be the case. (Paragraph 99)
14. Decisions on the
amount of activity required from the private sector have not been
based on evidence, but appear to have been 'plucked out of the
air'. The Department should specify criteria for private sector
involvement, for example failure to meet the 18-week target once
it is in place. The Department should make evidence-based decisions
and ensure value for money. (Paragraph 100)
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