Select Committee on Health Written Evidence

Evidence submitted by Amicus (AUDIO 19)

  Amicus is the UK's second largest trade union with 1.2 million members across the private and public sectors. Our members work in a range of industries including manufacturing, financial services, print, media, construction and not for profit sectors, local government, education and the health service.

  Amicus is the third largest trade union in the National Health Service and represents approximately 100,000 health sector workers. Amicus has members in primary care, mental health and acute NHS Trusts.


    —    Amicus believes the role being awarded to the private sector in audiology services poses a threat to the future of NHS Audiology services.

    —    Amicus is concerned at the lack of accountability in private sector health provision and the limited amount of consultation that has taken place regarding serious changes to an important area of service provision.

  1.  Amicus is deeply concerned about long-term NHS Audiology services due to the extensive future role the private sector is to play in service provision. This therefore forms the focus of Amicus' submission. The threat to NHS Audiology services outlined below must be placed within the context of wider NHS reforms and the drive to fragment healthcare provision between multiple providers outside of the public sector.

  2.  In July 2006 Lord Warner announced that 300,000 audiology pathways per year for five years would be purchased from the private sector, [3]due to come on stream during 2007. There will also be a national procurement of audiology services in the second phase of the ISTC programme. [4]Despite government assurance that both of these initiatives are additional to NHS Audiology services Amicus does not believe this will be the result.

  3.  It is unclear what evidence base there is for the "extra" 300,000 figure per year for five years in the purchase of pathways from the private sector, as figures for audiology services only began being widely collected last year. It is therefore difficult to project what resources are needed to meet future demand.

  4.  The RNID estimated for the British Academy of Audiology (BAA) the maximum number of episodes achieved in one year during in the highly successful RNID managed modernisation programme was 200,000. [5]The purchase of 300,000 pathways is supposed to be in addition to the ISTC procurement which will take place, representing a substantial increase in volume. Amicus fully supports effective attempts to cut audiology waiting times which deliver high-quality services to patients whose lives can be transformed. However, it is not clear the infrastructure exists within the private sector to deliver such volume, creating further future problems in service delivery. As stated above, both of these initiatives are supposed to be in addition to NHS capacity. However, it is feared that as both of these initiatives with the private sector involve a contracted and purchased number of episodes "up front" there will be pressure to route patients through the private sector to fully attain the contracted volume. This would be at the expense of NHS Audiology services.

  5.  The ring-fencing of NHS Audiology services ended in April 2006. This has led to Audiology departments experiencing disruption to services and being subjected to the same financial pressures as other sections of the NHS, due to the inappropriate funding and accounting policies pursued by government. Audiologists have reported vacancy freezes and service cuts, such as not having sufficient funding to buy enough hearing aids for patients. This must be considered when looking at the audiology waiting times.

  6.  Amicus does not believe it makes sense for the government to plough additional funds into private sector audiology services when NHS audiology departments are experiencing funding reductions. Amicus is concerned the government have adopted this approach rather than ring-fencing and investing these funds into NHS Audiology departments and allowing them to build capacity to reduce waiting times as they feel appropriate. The funded route of private sector provision effectively incentivizes financially pressured PCTs to transfer core NHS audiology services to the private sector, threatening the future existence of NHS audiology departments. Amicus believes the outcome will be the privatisation of audiology services by default.

  7.  The procurement of both private sector audiology initiatives will fall under commercial confidentiality restrictions. As the committee is aware this limits democratic accountability, preventing a value for money comparison with NHS services to take place.

  8.  The transfer of core audiology services to profit-generating private sector providers will result in a portion of tax-payers' money being diverted away from service provision.

  9.  Finally, Amicus wish to echo the disappointment expressed by the BAA over the lack of staff consultation regarding the two private sector initiatives. The purchasing of 300,000 annual audiology pathways and the inclusion of audiology in the ISTC programme were announced prior to the publication of the National Action Plan. Staff have a wealth of experience to contribute to planning, and all stakeholders must be involved in the designing of future services if reforms are going to be for the better.

Kevin Coyne

National Officer for Health


8 February 2007

3   HL Deb, 25 July 2006, Col 1641. Back

4   For example, see Hansard, Written Answers, 14 December 2006, Column WA 222. Back

5   BAA, NHS Audiology-Building the Service, 2006, page 7. Back

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