Select Committee on Health Written Evidence

Evidence submitted by The Hearing Aid Council (AUDIO 42)


  The Hearing Aid Council is the statutory body that registers and regulates individuals and organisations involved in dispensing hearing aids. The Council was established by the Hearing Aid Council Act 1968 (as amended). The Act makes it a criminal offence for someone to dispense a hearing aid in the UK unless they are registered with the Council. [16]

  The Council has a number of statutory functions, and is required to:

    —  maintain a Register of Hearing Aid Dispensers and a Register of Employers of Hearing Aid Dispensers; [17]

    —  define eligibility criteria for registration with the Council, through its approved Standard of Competence. This sets out the education and training requirements for practice as a hearing aid audiologist required before an individual may register as a hearing aid dispenser;

    —  set out a Code of trade Practice that governs how hearing aid dispensers should conduct themselves when dispensing hearing aids. The dispensing of hearing aids requires regulatory intervention for three reasons: because of the healthcare relation between dispenser and client, because of the asymmetry of knowledge between dispenser and client resulting from the highly technical nature of aids and because of the additional vulnerability of clients arising from their general old age and the practice of selling aids in the client's home. The Council's approved code of trade practice sets out standards and rules of conduct in relation to each of these three areas of regulatory need; and

    —  investigate whether registrants have breached the code of trade practice and take disciplinary action where appropriate. The Council has semi-judicial disciplinary functions, and has the power to admonish, fine or remove from the register those individuals and organisations found guilty of breaching its codes.

  Unlike most healthcare regulators, the Council does not how fitness to practice powers.


  1.  There are currently c 1,350 Registered Hearing Aid Dispensers in the UK and c 200 registered employers of dispensers. Each year, around two hundred individuals register with the Council for the first time.

  2.  Five companies currently employ around two thirds of existing dispensers and 90% of newly registered dispensers. These five companies are collectively known as "national training companies". They provide work-based training for individuals working towards registration and practice as dispensers. While the Council does not collect information about volume of sales or turnover, it is understood that these five companies account for a large market share of both.

  3.  Of the five largest companies, four have been trading for a number of years and generally before the introduction of statutory regulation. In the past three years, aggressive market share development has been undertaken by a new entrant to the marketplace. By the end of this year, it is expected that this new entrant will be the largest company in terms of employees, turnover and volume of sales.

  4.  Dispensers not employed by one of these five companies are generally involved in small organisations: typically sole traders or organisations of less than five employees. Of those newly registered dispensers that were not trained by one of the national training companies, half (5% of the total) are audiologists working in the NHS who wish to dispense and half (5% of the total) are individuals trained by a small dispensing organisation.

  5.  In March 2005, the Government announced its intention to abolish the Hearing Aid Council and transfer its regulatory functions to other bodies. The Council welcomed this proposal, and has taken the opportunity to make recommendations to Government about the future regulation all professionals involved in hearing aid audiology.


  6.  The Committee has stated that it is interested in five specific questions, namely:

    —  whether accurate data on waiting times for audiology services are available;

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

    —  whether the NHS has the capacity to treat the numbers of patients waiting;

    —  whether enough new audiologists are being trained; and

    —  how great a role the private sector should play in providing audiology services.

  7.  The first three questions relate to the provision of audiology services within the NHS and the Hearing Aid Council does not have a view on these matters. The Council does have views on the final two questions, and these are set out below.

Are enough audiologists being trained?

  8.  Different standards of education and training operate in the independent and NHS sectors. There is no system of formal recognition of education and training across the two sectors. The Council believes that the lack of common education and training significant impacts on the operation of the audiology labour market to the detriment of hearing aid users.

  9.  As part of the work programme in preparation for the future regulation of all professionals involved in hearing aid audiology, the Council is working towards developing and implement a Foundation Degree qualification in audiology. It is intended that the Foundation Degree will be the threshold entry qualification for entry to the future statutory register for all hearing aid audiologists, including those working in the NHS and independent sectors. The Foundation Degree has been developed by the Hearing Aid Council with the three professional bodies covering hearing aid dispensers and audiologists, namely the British Academy of Audiology (BAA), the British Society of Hearing Aid Audiologists (BSHAA) and the Association of Independent Hearing Health Professionals (AIHHP). The Council anticipates that by the end of 2007-08, it will have approved six Foundation Degree courses and that the first output from these courses will be on the employment market by September 2008. The Council has kept the Department of Health informed of progress, and the department has supported this process through provision of external consultancy support.

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

  10.  Whether, and to what extent, the private sector should play a role in providing audiology services is a matter for the Government, and the Council does not a specific view on this subject. The Council does, however, have specific views about how the private sector (and indeed all audiologists) should be regulated.

  11.  The current regulation of hearing aid audiologists is simply not fit for purpose and is not consistent with Government policy in relation to the regulation of health care professionals. Currently, different standards operate in the independent and NHS sectors. Standards in the independent sector are determined by the Hearing Aid Council, as a statutory body responsible for regulating the sale of hearing aids. In the NHS, there are a mixture of standards which are determined by professional bodies, local NHS trusts, voluntary registration bodies[18] and the Health Professionals Council. [19]This means that hearing aid users cannot easily determine whether an audiologist is covered by a statutory regulation regime, and if so by which regulatory authority.

  12.  The Hearing Aid Council believes that the current position is not in the best interests of hearing aid users. Hearing aid users have a right to expect a common standard of professional conduct, regardless of how they access hearing aid services. The Council has therefore recommended to Government that all audiologists should be registered with and regulated by a statutory body to a single set out standards. The Council believes that the Health Professions Council (HPC) is the most appropriate regulator in this regard, and is working with the Department of Health and the HPC towards this end.

  13.  The impact and potential risks of this fragmented regulatory framework is apparent in the recent Private Public Partnerships (PPPs) covering hearing aid audiology services. A number of NHS trusts have contracted with private sector dispensing companies for the provision of hearing aids to NHS clients. These contracts are generally with one of the five national training companies mentioned above. However, as the hearing aid is not provided by way of retail sale, the provisions of the Hearing Aid Council Act 1968 (as amended) do not apply. Dispensers providing services via a PPP contract are generally not regulated either by the HPC or the Registration Council for Clinical Physiologists (RCCP). Nor are their employers or premises covered by the Healthcare Commission's Standards for Independent Healthcare Providers. Indeed, unless the procuring Trust specifies its own regulations and standards, the provision of hearing aids through PPPs is completely unregulated.

  14.  Over and above the lack of common standards across all hearing aid audiologists, the Council believes that the current statutory basis for regulating dispensers is outdated and not fit for purpose. Specifically, there are a number of gaps in the current legislative framework, including:

    —  no fitness to practice powers;

    —  no externalisation/separation of investigations and disciplinary functions;

    —  limited scope for disciplinary action;

    —  limited scope for risk-based regulation;

    —  limited inspection and direction powers;

    —  regulation focused on sale with oral negotiation, and may exclude internet and direct mail sales; and

    —  functions cover employers and individual professionals.

  The small size of the regulated market limits the size and resources of the Hearing Aid Council. The Council does not believe the current regulatory framework is fit for purpose.


  15.  The Council believes that the current regulatory framework covering hearing aid audiologists is not fit for purpose. The fragmented and complex system of statutory and voluntary regulation and unregulated professionals, coupled with the lack of common standards of education, training and practice is detrimental to both hearing aid users and hearing aid professionals.

  16.  Such common standards should ensure that all hearing aid audiologists are trained and have the skills and experience to practice in a safe and effective manner, making appropriate clinical decisions and providing hearing aids that maximising a person's hearing gain. The Council wants to see common standards that apply to all hearing aid audiologists, allowing individuals to practice freely in both in the independent and NHS sectors.

  17.  The announcement by the Government of its intention to abolish the Hearing Aid Council and the acceptance by Ministers of the need for statutory regulation of clinical physiologists are an opportunity to ensure that all hearing aid audiologists are regulated on a statutory and single basis. Without such change, any re-structuring or re-balancing of the education and training of hearing aid audiologists practicing in the private sector, or any move to increase the provision of audiology services through the private sector (either as private healthcare or NHS care delivered by private providers) will create significant regulatory risk to hearing aid users.

Chris Hughes

Chairman, The Hearing Aid Council

12 February 2007

16   Dispensing is a process that involves an individual conducting or seeks to conduct oral negotiations with a view to effecting the supply of a hearing aid, whether by him or another, to or for the use of a person with impaired hearing. It excludes aids provided via the NHS and some aids sold via the internet or direct mail. Back

17   The Council is one of a small number of professional regulators that has responsibility for employers as well as individual professionals. Similar regulators include the General Dentistry Council and the General Optical Council. Back

18   For example, the Registration Council for Clinical Physiologists is a voluntary registration body for clinical physiologists, including those involved in the provision of hearing aids. The Health Professions Council has recently made a recommendation to the Secretary of State for Health pursuant to the provisions of the Health Act 1999 that Clinical Physiologists be covered by statutory registration and regulation. Back

19   The Health Professions Council regulates clinical scientists, including those involved in provision of hearing aids. Back

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