Select Committee on Health Written Evidence

Supplementary letter from the Department of Health (AUDIO 1A)


  During my appearance at the Committee's oral evidence session on 8 March, I undertook to write to you on a number of points.


  We discussed changing the way services are provided in order to address the waiting times issue. The Department is working with eight development sites to identify the efficiencies to be gained through improved waiting list management, better skill mix, streamlined referrals and new technology. Open-fit technology, which enables assessment and fitting to take place during the same appointment, is also being trialled at a further four sites. A list of all the NHS sites currently trialling the open-fit hearing aid technology is at Annex A.


  The Committee raised two queries in relation to the PPP. Firstly, whether either the Department or the NHS Purchasing and Supply Agency (PASA) encouraged the NHS to work with private providers outside the PPP contract. The PPP was specifically developed as part of the MHAS programme to provide the NHS with a framework with which to work with the private sector. The PPP was open to all NHS trusts who had modernised and were routinely fitting digital hearing aids. Those trusts were free to decide locally whether to use the PPP.

  As part of the modernisation programme, RNID provided support to encourage the use of the PPP in areas where waiting times were relatively high. Given the availability of the PPP across the NHS and the focus that had gone in to negotiating an effective contract, there was no reason for either the Department or PASA to encourage the NHS to work with the private sector outside the contract. However, in the same way that the NHS locally was free to make use of the PPP, it was equally free to engage with private providers outside the contract, and we recognise that this did occur with some services.

  Secondly, the Committee raised a point in relation to evidence given by Charing Cross Hospital Audiology Service relating to concerns that services provided through the PPP did not present value for money. The PPP included a number of contract terms to ensure that contractors provided services of appropriate quality to NHS patients. As part of this process, it was the responsibility of the local trust and the private provider to discuss and agree the specifics of what would be provided, and for the head of audiology within each trust to manage the contract at a local level. Any issues that were unable to be resolved locally, could be escalated to PASA.

  Quality Assurance was a key part of the national framework agreement and both companies involved in the PPP demonstrated their commitment to meeting the contract standards. They invested resources in equipment, IT and staff training. The intention of the PPP was to enable capacity to be provided outside acute hospital settings, and local discussions between trusts and providers would have agreed where these services would be provided.

  I would of course be happy to share with the Committee the comprehensive package of the PPP contract's full terms and conditions if this would be of interest.


  An we indicated to the Committee, the cost of procuring a pathway through the independent sector is broadly comparable with the cost in the NHS.

  The cost of the patient pathway as part of the PPP independent sector contract was between £150 and £185. These figures do not include the cost of the digital hearing aid which would increase the cost of the pathway by between £67 to £195 dependent on the specification of the aid.

  Modelling using 2004-05 Reference Cost data on stages of treatment and 2005-06 PASA data on the cost of hearing aids suggest that in 2005-06 the cost of an assessment, fitting of two aids and follow up in the NHS was £334. If one aid was fitted it was £253.

  I referred to the figure of £270 at the Health Select Committee, which is between these costs. It should be noted that this analysis draws heavily on the cost of hearing pathways that have been referred via ENT and that we do not collect data on the cost of pathways that are referred directly to audiology departments. The cost also does not reflect the efficiency that can be gained through implementing the innovative solutions set out in Improving Access to Audiology Services in England.

  I hope this is helpful. I look forward to reading the Committee's findings and recommendations from this inquiry.

Ivan Lewis MP

Parliamentary Under Secretary of State for Care Services

Department of Health

30 April 2007

Annex A


Royal South Hants Hospital, Southampton.

Leeds Teaching Hospital, Leeds.

Selly Oak Hospital, Birmingham.

Princess of Wales Hospital, Bridgend, South Wales.

Royal Devon and Exeter Hospital, Exeter.

Leicester Royal Infirmary, Leicester.

Basildon Hospital, Essex.

University Hospital (Audiology Central Outpatients), North Staffordshire.

North Manchester General Hospital.

Withington Community Hospital.

Norfolk and Norwich University Hospital.

Royal Bolton Hospital, Bolton.

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