Evidence submitted by Mark Brindle, Queen
Elizabeth Hospital King's Lynn NHS Trust (AUDIO 32)
EXECUTIVE SUMMARY
It is possible to provide record accurate data
on waiting times however the Audiology patient management systems
available through the NHS Logistics do not lend themselves to
obtaining this information easily.
There are still a large number of people waiting
to be reassessed and changed from an analogue hearing aid to a
digital one. New referrals are being seen within the targets.
Additional support staff are required in Audiology
departments not additional audiologists. This would be a more
effective use of resources.
If the private sector were to be involved in
providing Audiology services would the continuing care required
also be provided by the private sector or would the Audiology
department be expected to see them for their continuing care?
INTRODUCTION
I have worked within the field of Audiology
for the past 25 years. Starting as a student and now running a
typical medium sized department. Working as a team we have always
tried, and mainly succeeded, in introducing many new and innovative
ideas. A good number of the ideas for modernisation and creative
ideas for Audiology Departments were introduced locally some time
ago. For example, Assistant Audiologists first started working
in the department over 10 years ago. They are now invaluable and
release significant amount of Audiologist time for performing
more technical and demanding tasks.
This memorandum is written from the perspective
of a forward thinking, award-winning medium sized department providing
hearing and balance services to a wide range of people numbering
over 12,000. All services are provided at the main centre and
most of those services are also offered at six centres located
in the local community.
1. Accurate data on waiting times are possible,
however at least one of the two, if not both Audiology Patient
Management Systems available through NHS purchasing, do not allow
for easy recording and extraction of statistical information.
Until the Guidance on completing the diagnostic waiting times
and activity monthly data collection, valid from the 31 October
2006 was published the information of what to include and what
not to include in the monthly return was very much open to local
interpretation.
2. The historically low investment in Audiology
was only part resolved when the service went through the Modernisation
of Hearing Aid Services (MHAS) process. Very little account was
taken of the large numbers of current NHS hearing aid users who
would want to be reassessed and have their analogue hearing aid
replaced with a digital one. Thus there are large waiting times
for reassessments at many hearing aid centers.
3. This department is able to provide a
service to patients following the MHAS protocols and keep within
the Government targets with the present or near to the present
level of resources. It cannot however provide this service to
new referrals, keep all present NHS hearing aid users operating
and reassess those who wish to change from an analogue hearing
to a digital one, in sufficient numbers the result being very
long waiting lists for the latter.
4. If all analogue hearing aids could be
changed over to digital ones then the reassessment waiting times
would shrink significantly. With only those having difficulty
with their present digital aid requiring reassessment. Therefore
the pressure on the department could be greatly eased if this
cohort of people were taken out of the equation. It may be possible
for the private sector to perform this task.
5. There are 4.6 WTE Audiologist in the
department, 2.5 WTE Assistant Audiologists and 1.2 WTE Clerical
staff. The ratio of Audiologists to other staff is much lower
than in most Audiology Departments. This ratio could be further
reduced with the introduction of the Associate Audiologist grade.
These AfC Band 4 staff could perform some of the routine work
of the Audiologists thereby freeing up some of their time. Thus
the capacity of the department could be increased with much less
investment and in a much shorter time and with less pay expenditure
than Audiologists. There clearly needs to be sufficient numbers
being trained to replace those leaving the profession and some
extra for the aging population. There need not be a "dumbing
down" of services simply because additional staff are employed
within the profession who do not have a degree qualification.
There need to be clear and agreed roles so that the work of Audiologists
is not performed by inappropriate staff.
6. Consideration will be required to be
given to the sustainability of providing an open-ended service
to all people once they have been issued with an NHS hearing aid.
With an ever-increasing elderly population it is almost certainly
unaffordable to continue to provide the present level of hearing
aid service.
7. Following on from other specialities
the wide and varied work performed by Audiology Departments needs
to be included within the Payment by Results remit using costs
that accurately reflect the work performed. Only then will the
work performed by each department and their associated costs be
comparable.
8. If the private sector were to provide
audiology services to significant numbers of people, then would
they be willing to provide the continuing care that hearing aid
users require to get the most from their aids. If not, then those
people would have to return to the NHS Audiology Departments who
in turn would not be able to keep waiting times down without some
investment.
RECOMMENDATIONS
Employ many more Assistant Audiologists (AfC
Band 3) and the widespread and urgent introduction of Associate
Audiologists (AfC Band 4) using a competence based training program
such as the one being looked at by the heads of Audiology in the
East of England. These staff groups to perform many more of the
routine tasks in Audiology by support staff.
To begin a debate on the appropriateness and
financial sustainability of Audiology Departments providing an
open-ended hearing aid service to NHS hearing aid users.
Mark Brindle
Audiology Services Manager, The Queen Elizabeth Hospital
King's Lynn NHS Trust
8 February 2007
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