Select Committee on Health Written Evidence

Evidence submitted by Amplifon UK (AUDIO 20)


  Waiting times for uncomplicated hearing impairment have increased mainly due to the improvement in patient treatment through the provision of digital hearing aids. More audiologist time and therefore resources are required, yet the number of audiologists being trained for the NHS has reduced and that the number of audiology graduates is making no discernable contribution to capacity.

  The private sector has a role to play in providing capacity in terms of dealing with the excess waiting times and supporting NHS resources ongoing. The recent PPP has already demonstrated that waiting lists can affordably be reduced from two years to one to two months, with no reduction in quality of patient care or service.


  Amplifon UK Limited and its subsidiaries is the largest private sector audiology dispensing group in the UK and has been involved in adult hearing aid services since 1935, treating over 500,000 patients both privately and through the NHS.

  The subsidiaries include Ultravox, Amplivox+Ultratone, Sietech Hearing, Hearing Health and Amplivox. Amplifon, as the largest employer and training company within the profession in the UK, has participated in public and private committees and activities including:

    —    MAWFET—National workforce planning committee chaired by DoH;

    —    BSc Steering group—National committee involved with establishment of BSc Audiology;

    —    Patient management user groups—NHS Audiology departments compile their data using one of two patient management systems, Auditbase or Practice Navigator. Amplifon (through Ultravox) was a member of both user groups giving us a clear insight into how data is defined and collated across NHS audiology;

    —    PPP Contracts—As the largest contractor working with over 75 PCTs and Hospital Trusts on the largest public private partnership in Audiology.

Whether accurate data on waiting times for audiology services are available

  1.  In short, the answer to this important question is no. There are many reasons for the data's inaccuracy but they can be summarised thus: Diagnostic activity (in other words, "hearing assessments") is the only data being collected and/or reported. Audiology activity in its fullest sense, from referral to treatment by way of hearing aid provision, is not measured. It is this which ultimately impacts on waiting times. A hearing assessment can be given to a patient many times along their pathway before final discharge. Therefore, the collected data contains duplications. Local pressures can affect the interpretation/definition of the data presented (for example, ALL patients or NEW patients, ALL assessments or NEW assessments).

  2.  Nevertheless, we believe that data trends are reliable and thus the length of waiting lists reported can be taken as a minimum with some confidence. A survey carried out by the British Society of Hearing Aid Audiologists (BSHAA) reports increasing waiting times. At the last report this was in excess of nine months in England.

Why audiology services appear to lag behind other specialities in respect of waiting times and access and how this can be addressed?

  3.  NHS Audiology is comprised of essentially five categories:

    —    Paediatric services.

    —    ENT support.

    —    Vestibular.

    —    Newborn screening.

    —    Adult hearing aid services.

  NHS services are provided by trained and qualified audiologists who provide service across the categories. There are approximately 3,000 NHS audiologists.

  4.  The greatest part of the NHS Audiology service is made in the "Adult hearing aid services" category. This is Amplifon's area of specialisation and we contain our comments to this category.

  5.  In terms of this category, the principal reason that the NHS lags behind other specialities is the additional time demand as a result of the introduction of digital hearing aids (to replace analogue) as part of the MHAS (Modernising Hearing Aid Services) initiative. The results of this are:

    —    The quality of the improvement in hearing and patient satisfaction is considerably improved, yet the cost of the hearing aids has not significantly increased.

    —    The time spent by the patient with the audiologist has increased threefold (from 45 minutes to 135 minutes per patient journey).

    —    The technical expertise requirement for the audiologist is increased because of the fitting requirements of the digital hearing aid. This continues to be the case as technology evolves and improves.

  6.  NHS clinical priorities do not include those with uncomplicated hearing impairment as they have no directly associated acute or chronic health conditions. This lack of priority for adult hearing aid services is in spite of there being a highly cost effective solution for maintaining active, independent living, improved quality of life and reduced risk of ill health.

  7.  The population of NHS audiologists has not increased commensurately, so waiting times have increased and are increasing. Looking forward, the ageing population will result in proportionately more patients requiring adult hearing aid services, thus requiring more resources. There are no national targets applicable to adult hearing aid services as they are not Consultant-led services.

  8.  This issue can be addressed by one or both of the following:

    —    increase the number of NHS audiologists to meet expected ongoing demand;

    —    partner with the private sector to reduce the waiting lists while NHS audiologists are recruited and trained; and

    —    partner with the private sector fully and transfer all adult hearing services and resources to the private sector.

Whether the NHS has the capacity to treat the numbers of patients waiting?

  9.  This question was recently addressed by Dr Sue Hill, Chief Scientific Officer at the British Academy of Audiology annual conference. The statistics she produced show there is not enough capacity from within the NHS alone to deal with the patients waiting the anticipated future demand on the service.
Current NHS activity 258,000 new patients
258,000 reassessments
67,000 DNA (Did Not Attend)
420,000 hearing aids fitted
40,000 do not require a hearing aid (medical referral)
Waiting lists (estimated)250,000
Rate of growth63,000 per annum
Estimated unmet need60,000 per annum

  10.  Any reduction in the waiting list or elimination of the increase in waiting time cannot be achieved without significant additional resources. We believe the NHS will need to draw upon all the resources available to it, both within the Service and within the private sector.

Whether enough audiologists are being trained?

  11.  We are not aware of the details of numbers or skills being trained for the NHS system. However, we believe that the number of audiologists being trained for the NHS has reduced and that the number of BSc (Audiology) graduates is making no discernable contribution to capacity.

  12.  The independent sector has a continuous programme of training Registered Hearing Aid Dispensers (Amplifon trains and qualifies 60 per year), which is managed under the Standards of Competence of the Hearing Aid Council.

How great a role the private sector should play in providing audiology services?

  13.  NHS Audiology is comprised of essentially five categories:

    —    Paediatric services.

    —    ENT support.

    —    Vestibular.

    —    Newborn screening.

    —    Adult hearing aid services.

  14.  In terms of Adult Hearing Aid services, which is Amplifon's specialism, the characteristics of appropriate private sector companies we recommend that the Committee considers the following:

    —    Primary competence in hearing aid audiology.

    —    Availability of sufficient numbers of hearing aid audiologists with the skills to address the waiting lists and posing minimal risk to the Department of Health, through its practices, processes and demonstrable quality of service.

    —    Sustainable with a long term commitment to hearing care.

    —    Availability of practice staff.

    —    Consulting room capacity.

    —    Proximity to patient groups and hospitals and, especially in conurbations, in High Street locations.

    —    An established IT infrastructure and connectivity.

    —    Prior experience through PPP involvement.

    —    Product knowledge and key manufacturer relationships.

    —    Capacity and willingness to apply investment in joint venture working and improvements in cost of service provision.

  15.  The private sector has already played a successful role in providing audiology services to the NHS through the PPP and ISTC diagnostics.

    —    80,000 patients have been supplied with a digital hearing aid via PPP.

    —    Patients have been assessed within four weeks.

    —    Fitting takes place within four weeks of assessment.

    —    The patient journey is completed within 12 weeks of fitting.

    —    Waiting lists reduced from two years to one to three months.

    —    In Bournemouth PCT for example over 4,000 patients were successfully supplied with digital hearing aids within 18 months.

  16.  Professor Adrian Davis, Head of the Institute of Hearing Research (Medical Research Council) has evaluated the PPP and published his findings including the following:

    —    Patient satisfaction from patients who were seen by IS providers via PPP was at worst equal to and usually better than NHS partners.

    —    He further went on to report that with the PPP providers (Amplifon, through Ultravox, being the largest), compliance with contract protocol and specification was 99% compared to 60% with NHS services.


  17.  As the world's largest provider of hearing aid services we have an enormous reservoir of information and experience we would be happy to share with the Select Committee. If the Select Committee decides to take oral evidence we would be a willing participant.

Jeffrey Murphy

Chief Executive, Amplifon UK Ltd

12 January 2007

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