Select Committee on Health Written Evidence

Supplementary evidence submitted by the Royal National Institute for Deaf People (AUDIO 23A)

  We are grateful to the Health Select Committee for giving the issue of unacceptable waiting times for hearing aids—and the underlying shortfall in service capacity—the thorough attention it deserves.

  The Department of Health published its report "Improving access to audiology services in England" since we submitted our written evidence, and several questions and issues were raised in the evidence session on 8 March relating to this report, on which we should like to offer further comments to the Committee.


  The Department of Health collects and publishes waiting time data for hearing assessment, but appeared reluctant to commit to collecting and publishing data on the subsequent wait that people experience between hearing assessment and actually having their hearing aids fitted. We can see no reason why provision of this data should create any greater difficulty for service providers and commissioners than the collection of waits for assessment. We consider that if the Department of Health is unwilling to collect and publish this data, it undermines the credibility of their stated intention to radically reduce waiting for hearing aids.


  In the absence of additional capacity, the Department of Health's direction that people should have their hearing assessed within the six-week diagnostic milestone (by next year)—while setting no explicit target for the fitting of hearing aids—is likely to mean that people will wait even longer after having their hearing assessed before actually obtaining their hearing aids. If this wait is longer than three months, they will need to be assessed again because their hearing may have deteriorated. This will clearly be wasteful of the already-stretched NHS capacity.


  In his evidence to the Committee, the Minister placed heavy reliance on the use of new "open ear fitting" technology as a major means of releasing substantial capacity in the NHS and reducing waits, since it enables one-stop assessment and fitting of hearing aids on the same day. This technology is well known to us and we have followed the progress of the pilot studies using open ear fittings with interest. Our understanding is that the final evidence from the pilots is not available yet. Only when the analysis of the outcomes for individuals at follow-up interview has been completed, and the final report is published, will we know the proportion of patients for whom this technique is actually appropriate. It is certainly premature to claim that it will be suitable (let alone optimal) for the majority and, even if this proves to be the case, it is not clear how much capacity could thereby be released in practice. Much longer appointments will be needed for the one-stop approach and—even if it proves possible to establish in advance of the patient's visit the general likelihood of this being suitable for them—there will be some wastage of time in cases where it is found that after all they need a traditional fitting, which will involve curtailing the visit and booking a further appointment.

  The claim that this new technology will provide a key solution to the waiting time problem is premature in our view and clearly flouts the principles of peer-reviewed, evidence-based healthcare.

  We welcome the incorporation of open ear fittings into service protocols because of the benefits in terms of hearing, comfort and handling that they offer to individuals for whom they are an appropriate solution. However, we cannot judge their potential contribution to service efficiency until the evidence is available.


  We maintain that the increase in capacity required in order to meet increasing demand and achieve a radical reduction in waiting times will require involvement of the independent sector. Although some NHS audiology services have been successful in securing resources for local capacity initiatives from their PCTs and have reduced waiting times substantially, people needing hearing aids for the first time still face waits of well over a year in many areas and over two years in worst cases.

  Our judgement is that if a commitment to a national contract to procure well over 100,000 patient journeys from the independent sector has not been made by the time that the Health Select Committee reports on its inquiry, it is inevitable that the Department of Health's strategy for improving access to services will fail.

  We thank the Committee for its work and look forward to the report on its inquiry.

Royal National Institute for Deaf People

March 2007

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