Evidence submitted by Amplifon UK (AUDIO
20)
EXECUTIVE SUMMARY
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.
INTRODUCTION TO
THE SUBMITTER
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:
— 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 growth | 63,000 per annum
|
| Estimated unmet need | 60,000 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:
— 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.
FURTHER INFORMATION
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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