Evidence submitted by the British Society
of Hearing Aid Audiologists (AUDIO 10)
BSHAA is the professional membership body for
Hearing Aid Audiologists in the High Street.
Across the UK there are 1400 practitioners:
trained, state-registered and regulated specialists in assessing,
fitting and rehabilitating patients who need hearing aids. They
are up-to-date in constantly improving hearing instrument technology.
They practice in almost every town centre and undertake domiciliary
visits.
Their standards of professional, clinical and
consumer practice have been regulated by the statutory Hearing
Aid Council for over 40 years. They welcome the prospect of becoming
registered and regulated healthcare professionals within the Health
Professions Council in the near future. Most already have good
professional relationships with NHS audiology departments, GPs
and local hard of hearing voluntary organisations.
We believe that Hearing Aid Audiologists in
the High Street are a unique and unparalleled professional resource,
with the potential to provide an immediate, quality, locally accessible
and cost-effective hearing aid service to NHS patients.
EXECUTIVE SUMMARY
The NHS does not appear to collect full information
on the local and national pictures on patients waiting for audiology
and hearing aids, at all stages in the journey from presenting
need to final delivery of service.
Estimates have been made that 500,000+ patients
may be on various forms of waiting lists.
The NHS does not give priority to non-acute
hearing disability. As a result there is insufficient investment
in hearing aid provision, and NHS audiology departments have neither
the funding nor staff to reduce waiting lists. Indeed, waits are
getting longer, and new graduate audiologists are not able to
find NHS jobs.
Declared Ministerial aims for "a long-term,
sustainable, low wait solution" and "a digital hearing
aid for everyone who needs one by 2005" appear far from achievable.
The numbers of patients, the length of their wait, and the underlying
unmet need—requires immediate, substantial and sustained
government action and investment. The Government needs to get
serious about giving patients the means of access to hearing care—free
at the point of delivery—which the NHS accepts that they
need.
The skills and capacity of NHS professionals
for specialist audiology; and independent Hearing Aid Audiologists
for adult hearing aid dispensing; need to be fully engaged and
the systems freed up to allow this to happen efficiently and effectively.
The 1,400 Hearing Aid Audiologists practising
on the High Street have the potential to provide an accessible,
flexible, quality assured, specialist hearing care service to
NHS patients. Using marginal capacity could offer almost immediate
delivery. Opening up the NHS to the hearing aid market would benefit
patients and consumers. Competition would improve choice, quality
and cost.
The National Audiology Action Plan should develop
the national frameworks and funding; for PCTs to be enabled to
commission hearing care from the local market place; giving patients
timely choice and access to services which meet their needs.
Whether accurate data on waiting times for audiology
are available
1. The NHS does not appear to collect, and
certainly does not publish, full information on the local and
national pictures on patients waiting for audiology and hearing
aids, at all stages in the journey from presenting need to final
delivery of service. Estimates have been made by the RNID of 500,000+
patients needing a hearing aid, on a waiting list for assessment
or fitting, or waiting for reassessment for a digital up grade.
2. Declared Ministerial aims for "a
long-term, sustainable, low wait solution" and "a digital
hearing aid for everyone who needs one by 2005" appear far
from achievable. The scale of the problem—the numbers of
patients, the length of their wait, and the underlying unmet need—requires
immediate, substantial and sustained government action.
3. SHAA's survey of the length of time it
takes for someone with a hearing loss to obtain a hearing aid
from an NHS hospital or community clinic records the experience
of patients. [11]In
England the average wait has risen for the third successive year,
to 48 weeks. In some areas patients have to wait up to 117 weeks
for their first hearing aid, and up to five years for a digital
replacement. Things have improved over the past year for people
living in Scotland, Northern Ireland and Wales, but things have
got significantly worse in England with 41% of hospitals having
increased waiting times.
4. There are significant regional variations.
The North East and the South West saw significant increases in
waiting times for a first hearing aid; the North West is the worst
for people seeking to replace analogue with digital. Our survey
is not a substitute for the NHS collecting and publishing its
own information on the total length of the wait, and the number
of patients waiting for hearing aids.
5. NHS information on the numbers and lengths
of patient waiting lists for audiology assessments is now published
as one of 15 diagnostic tests. 160,000 patients were recorded
as waiting to be assessed in NHS Audiology departments in November
2006. Worryingly, although audiology patients are only 20% of
the total number of patients waiting for any kind of test, they
comprise nearly 60% of all patients waiting over 13 weeks, and
over 75% waiting over 20 weeks. Over 100,000 patients are waiting
over 13 weeks for an audiology assessment, with no indication
how long any subsequent hearing aid fitting will take. 80,000
of them have been waiting for over six months. Many thousands
of patients waiting for a "re-assessment" to have their
hearing aid upgraded to current digital technology do not appear
in any national figures.
6. Estimates of 500,000 and more have been
made by the RNID for the real number of patients with a need,
waiting for hearing assessment, for hearing care, for a hearing
aid or for a digital up grade. Published demographic information
suggests that c 3 million people in this country could benefit
from a hearing aid. With an ageing population needs can only increase.
Why audiology services appear to lag behind other
specialities in respect of waiting times and access
7. Audiology suffers from the simple fact
that progressive hearing loss is an invisible condition, is not
life threatening and affects older people in the main. Any commissioner
having to make financial decisions between competing disciplines
will always relegate hearing care and audiology to the bottom
of their list of priorities.
8. There is no national target driving across
the board reductions in waiting times or the number of patients
waiting. Providing a hearing aid for an adult experiencing disability
through a progressive hearing loss is highly cost-effective, and
health and socially beneficial. It does not however appear to
be a priority for the NHS.
9. We had believed that the announcement
of 300k additional pathways of hearing aid care signalled government's
determination to solve the waiting problem once and for all. However
it now appears that this 300k is not supported by additional ring-fenced
resources. In the absence of investment, PCTs are not going to
be able to commission more local services; from either NHS or
independent providers.
Whether the NHS has the capacity to treat the
number of patients waiting
10. Many NHS audiology services appear stretched
beyond breaking point; under funded, under staffed; and with huge
backlogs of patients waiting for assessment, for their first hearing
aid, or for an upgrade to digital.
Whether enough new audiologists are being trained
11. New graduate audiologists coming off
degree courses commissioned by the NHS appear not to be able to
get jobs. Responding to increasing customer demand, independent
sector employers are funding the training of 300+ additional Hearing
Aid Audiologists coming on to the High Street each year for at
least the next four years. By 2008-09, these students will be
graduating from the new Foundation Degree in Audiology, with the
specific knowledge and skills to assess, fit and rehabilitate
patients needing hearing aids.
How great a role the private sector should play
in providing audiology services
12. In our view, the government needs to
get serious about giving patients choice and the means of access
to hearing care—free at the point of delivery—which
the NHS accepts that they need. The skills and capacity of the
NHS—for specialist audiology— and the private sector—for
adult hearing aid dispensing—need to be fully engaged and
the systems freed up to allow this to happen efficiently and effectively.
Opening up the NHS to the hearing aid market would benefit patients
and consumers. Competition would improve choice, quality and cost.
There are also increasing benefits from technology and quality
innovations, which could be locked in to the patient outcomes
specified.
13. Using the independent sector in the
High Street could offer local PCT commissioners an innovative,
flexible, long term and cost-effective route for meeting patients'
hearing aid needs. The patient's NHS prescription for hearing
care could be dispensed from the patient's choice of local, approved,
registered hearing aid specialists; within a nationally agreed
local contracting framework and tariff; to agreed, locally monitored
standards of clinical and quality assurance. Establishing nationally
the service outcomes, quality standards, contracting framework
and tariff would ensure the commissioning of a consistent NHS
service across the country; give clarity, consistency and assurance
to large and small scale providers signing up to providing an
NHS service; and reduce transaction costs. Locally, PCTs could
commission quality and cost-effective delivery from a wide range
of local providers; increasing flexibility, accessibility and
patient choice.
14. Given assurances that the NHS tariff
would properly cover their costs of delivering an NHS service
to a good comparable standard of care, many High Street practices
would be very well prepared to provide an on-going NHS service
for local patients. The potential High Street capacity at the
margin—from up to 1,400 practitioners in over 1,000 locations—is
considerable, and almost immediately available to start meeting
local needs, at least for new patients being referred by their
GPs.
15. The huge backlog of patients currently
waiting would only be able to be cleared by a large scale national
waiting list initiative, to which only the large national hearing
aid dispensing companies in the sector would have any significant
capability or potential capacity to contribute.
16. All developed countries are experiencing
similar increasing levels of hearing aid need in their populations.
How they have chosen to address this need in terms of state funding
and support varies, but forms of portable entitlement are common.
In our view, the government should consider what if anything can
be learned from our European neighbours, and from Australia which
has a mixed economy of hearing service provision. It has recently
published hearing rehabilitation outcomes for voucher-holders,
which could be readily transferable as quality standards into
the delivery of hearing aids to NHS patients by the independent
sector on the High Street.
17. The National Audiology Action Plan should
in our view develop, fund and pilot the necessary national frameworks
within which PCTs can locally commission flexible audiology and
hearing aid provision from the market place of NHS, High Street
and third sector provision.
The Action Plan needs to:
— be realistic and achievable in terms
of the resources, investment and timescales;
— be the route plan to achieving a
sustainable low wait solution for hearing aids for new patients
and to clear the backlog of current patients with long waits;
— make the NHS service entitlement
clear—and couched in terms of outcome standards for the
patient, not processes and inputs—for commissioners, providers
and patients;
— establish a robust and realistic
tariff structure to fund the patient's entitlement to NHS hearing
aid care, whether they choose to have it delivered by NHS or private
provider;
— establish a national contracting
and quality standards framework within which PCTs can commission
the hearing aid care required to meet the patients' entitlement
to NHS care, from a choice of NHS audiology departments and local
private providers; and
— use the full potential of the NHS
and private sector skills and capacity working in tandem, to meet
the needs in every local area.
Alan Torbet
Chief Executive, British Society of Hearing Aid Audiologists
2 February 2007
11 BSHAA, Suffering in Silence, 2006. Back
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