Select Committee on Health Written Evidence

Evidence submitted by Mark Brindle, Queen Elizabeth Hospital King's Lynn NHS Trust (AUDIO 32)


  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?


  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.


  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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Prepared 16 May 2007