Evidence submitted by The Hearing Aid
Council (AUDIO 42)
BACKGROUND
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.
SIZE AND
NATURE OF
REGULATED MARKET
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.
LINES OF
INQUIRY
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.
CONCLUSIONS
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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