Select Committee on Health Written Evidence

Supplementary evidence submitted by Claire Carwardine (AUDIO 13A)

  I was fortunate enough to attend the Inquiry last Thursday, into Audiology services in England. I am an NHS audiologist myself, and was pleased with the way that the Meeting went.

  However, I did feel that there were certain areas that could have been investigated further, and certain questions remain unasked:

    —    With regard to hospitals struggling financially, it would have been useful to understand how the D of H expects hospitals (and more specifically audiology departments) to improve their financial situation, if the PCTs redirect "business" and funding to the independent sector. This is, after all, tax-payers money, ending up in the pockets of private companies, not hospitals!

    —    How much of the MHAS funding went into technology and equipment, as opposed to staff? Modernising poorly staffed departments with computers allows staff to fit modern technology, but does not increase the ability or capacity of that department to see more patients.

    —    Waiting times alone do not give a full picture. There is a need to include number of patients waiting, staffing levels and size (in terms of population) of catchment area, then real comparisons can be made in terms of measuring resources versus waiting times.

    —    Where is the evidence to back up the statement that 50% of hearing aid referrals fall into the 18 week wait (as referred to by the minister on a number of occasions), as they come through ENT? This has not been the case for many years, since the introduction of direct access to audiology departments. At least, not in my experience, having worked in three areas of the country, or having spoken to colleagues in other departments.

    —    I imagine this may become the case, if GPs realize that patients referred through ENT are being seen more quickly, because they are included in the 18 week target.

    —    How do you pre-select patients who would be appropriate for "instant fits"? This cannot be determined until after the assessment. To expect GPs to screen the patients first, adds to their workload, and is dependent on the conditions in which the screen takes place.

    —    The time taken to perform a hearing assessment is approximately 15-20 minutes, the time taken to programme the aid, verify the fitting and counsel the patient is between 45 minutes to an hour. It is difficult to plan for "instant fittings" as you cannot determine who will be appropriate audiologically and free of wax. If the patients fails to attend, or has wax, discharge etc then that 45 minutes that has been allocated, will be wasted.

    —    Finally, an audiogram is not a prescription, Mr Murphy stated that it is common practice in Europe for a doctor or practitioner to issue a prescription. This, in fact, is not how it works. There is no free provisions of hearing aids (or NHS) in Europe. The practitioner will advise an individual that they require a hearing aid, and then they are, as he stated, free to go where they like. It is not strictly speaking, a prescription, and the customer pays for the hearing aid and service. I include a document, in which I have highlighted huge variations between commercial practice in Europe, and here in the UK. An audiogram is an assessment result, not a presription for treatment. Hearing aids are not the same as glasses. You only need to listen to a hearing aid to realize that.

    —    I am very fortunate to work for a Trust (in a neighbouring county to where I live), that has been wholly supported by our PCT from the very beginning of our modernization. We had three additional staff—on top of the three funded by MHAS—and having been well staffed, we have not developed waits in area of our service. We are currently a year ahead of our six week target for 2008. New patients are assessed within six weeks, with the hearing aid fitted four weeks after that. Reassessments ar usually seen within six weeks, and we are now beginning to retest patients who have already received a digital aid, but whose hearing has changed since it was initially fitted. We are now "selling" our services to adjacent counties to help reduce their waiting times, as we are surrounded by areas that have been poorly funded, since before MHAS, leading to unacceptable waits. This is obviously good for generating additional income into our area, but does not address the lack of funding for audiology in those same hospitals.

    —    If all the PCTs had funded their audiology departments well from the beginning of the change, we would not have all these people waiting for hearing aids throughout the country. It does come down to a lack of funding and a lack of staff, due to frozen, or cut, posts.

  I thank you for your concerns about the services available to the hearing impaired, and if I can, in any way, be of further assistance, please do not hesitate to contact me.

Claire Carwardine

Principal Audiologist

March 2007

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