Select Committee on Health Written Evidence

Evidence submitted by Claire Carwardine (AUDIO 13)

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

  1.  NHS audiology deals with two quite different areas:

(a)  Diagnostic services

  This area of work is predominantly to support the ear, nose and throat consultants (ENT), usually referred from clinic. The vast majority of hearing assessments referred this way, are performed on the same day as their consultant appointment. Diagnostic testing also includes neonatal screening (usually performed before the baby is discharged from the labour ward), balance testing, electrophysiological tests of the inner ear and nerve function and middle ear function.

(b)  Rehabilitation Services

  Hearing aid provision and counselling. This is the most time consuming. Following initial assessment and impression taking, a further appointment is required to fit the manufactured earpiece and hearing aid to the patient. This can take up to an hour to fit, it is not simply "given" to the patient. Programming, measurement and verification of the aids performance in the user's ear, explanation of how the aid works, what it is trying to achieve, operating the different functions, fitting and removal from the ear, instruction on battery replacement, and advice on what to do if the aid goes wrong.

  2.  However, we are being grouped together with diagnostic services, when our waiting times are being looked at, even for hearing aid provision. It would be more appropriate to put us with other therapists and counselors, given the amount of time required to see our patients through their journey (assessment, fitting, follow-up, on-going care).

  Alternatively, the two service areas should be assessed separately, diagnostic waiting times, and rehabilitation waiting times. This seems to be the most logical.

Does the NHS have the capacity to treat the number of patients waiting?

  3.  Without accurate figures of current waiting times, the number of patients waiting to be seen and the number of practicing clinicians, it is impossible answer this question fully, or accurately. The RNID, I believe, is trying to collate this information. However, it appears that there are huge variations in the time that patients are expected to wait across the country. These vary from 13 weeks to up to three years (the latter is obviously an unacceptable amount of time to wait).

  4.  In an attempt to try and reduce the waiting times in areas with long waits, some audiology departments with "zero waits" are providing additional cover to adjacent trusts/PCTs to help reduce their waiting times. These additional patient journeys are seen by staff on their days off, or at weekends. This eliminates any affect on their own departments' service. In this way, it may be possible to bring all waiting times to a similar period of time, without the involvement of external parties. This ensures a uniform service, maintained within the NHS, who all provide care and service to the same standard (as laid down by the MHAS guidelines). This way the patient remains within their local NHS based audiology department, leading to a seamless service (ie: they are not seen in one place for a set period of time, and then referred through a different system on a different site, after a period of time).

  5.  The question should be: Whether the NHS audiology service can be flexible enough to deal with the problem of waiting lists, itself. There appears to be little discussion or consideration of this proposal, although it is the most logical. Why consider the introduction of external parties before assessing the ability of the current national service to resolve it's own challenges?

  6.  Recognition of departments that have managed their waiting times appears to be overlooked. Using departments of best practice can only benefit the national service of hearing aid provision, through the NHS, and thus the patient.

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

  7.  Split services will not provide the most economical solution, or a set standard of care. It is true that the task ahead is a mighty challenge for NHS audiology services, and there are likely to be areas of the country where it is not possible for the NHS to reduce waiting times by itself, even with the help of nearby departments. In these particular areas it would be useful to have some support from the independent sector, where appropriate, as long as this service is provided to the same standards and quality of care laid down by the MHAS guidelines.

  8.  However, we are currently at a peak in terms of the number of patients waiting to be seen nationally, as those patients that have been fitted during the past 30 years, or more, make up the vast majority of those patients waiting to be seen, for an upgrade to modern technology.

  9.  It is true, therefore, that this is an acute problem, requiring an acute response. A short term involvement by the independent sector, until waiting times are reduced, may then be welcomed in certain areas that are genuinely struggling with their waiting times. This concludes that their involvement need only be minimal.

  10.  Once these patients have been upgraded the waiting lists will not maintain the numbers that are currently waiting to be seen. If we look at new referrals alone, the current NHS service could cope adequately, but it is the patients that have been seen previously that all need changing over from analogue to digital, that have created these waits.

  Contracts setting out a set number of visits for this service simply will not work:

    "Our patients are for life, not just a hearing aid fitting"

Claire Carwardine

6 February 2007

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