Examination of Witnesses (Questions 20-39)
DR JOHN
LOW, MRS
RUTH THOMSEN
AND MR
JEFFREY MURPHY
8 MARCH 2007
Q20 Dr Stoate: If you are doing so
well, why is it there is a big problem? If all these departments
up and down the country are being modernised and all having these
wonderful one-stop shops—which I have to say I have never
heard of—and Choose and Book. I cannot do that from my computer:
despite the fact that I use Choose and Book whenever I possibly
can, audiology is not listed. How come it is with you and it is
not elsewhere?
Mrs Thomsen: We started with no
waiting list when we were modernised. We were a hardworking department,
a teaching department, and we were able to raise some revenue
in order to keep our department up and running. We run a very
tight ship. We are a department of 11 audiologists covering Westminster,
Hammersmith & Fulham, Kensington & Chelsea, parts of Ealing.
We cover a big chunk of West London. We were constantly looking
at ways to improve the service. We are a very forward-looking
team. We welcome the modernisation. I think every hearing aid
centre in the UK has undergone modernisation, so we are not the
only ones with nice new computers. I think everyone has that.
Q21 Dr Stoate: We have heard from
some of the evidence we have received that the skill mix could
be changed to improve the way things are working. It sounds to
me as if you have already done that.
Mrs Thomsen: No. We are still
looking at different ways of skill mixing. The introduction of
the foundation degree, which will hopefully come on board in September
2007, will create a new role, which is an associate level audiologist,
and uniform education, in terms of assistants, associates, qualified
audiologists who will then go up the ladder and specialise.
Q22 Dr Stoate: You are saying the
skill mix could go a lot further.
Mrs Thomsen: Absolutely. But it
is going. It is just taking time.
Q23 Dr Stoate: Do you think skill
mix would make a huge difference to the problem? Or do you think
it will only make a partial difference to the problem?
Mrs Thomsen: The skill mix and
a look at the establishment within an audiology department. A
really good look at whether you have qualified audiologists doing
stuff that associate level audiologists could do would help get
these patients through, so that the people with the high knowledge
are able to do the bits requiring the high knowledge. The problem
with that is you do need to be able to do the basics as well.
I think skill mix is important, but I think we need to look at
the way we recruit. We have all these new BSc students about to
exit this summer, from eight universities, I think, and we are
not lined up for that in audiology. We are not lined up for lots
of people to come on to the job market suddenly, all at once.
It is really important that we look at the way we recruit and
bring these people into the department and really make use of
their skills as well.
Q24 Dr Stoate: You are saying that
the skill mix will not take care of the entire capacity problem
but it will make a big difference.
Mrs Thomsen: I think it will help
a lot. I think the establishment of a foundation degree for hearing
aid dispensers and people working in the private sector will give
them a uniformity of qualifications.
Q25 Dr Stoate: We have heard of these
graduates coming through the system and yet we are also hearing
that many of them are struggling to find work. How do we get around
that paradox?
Dr Low: It is simply an issue
about capacity. Charing Cross is among the elite in the country.
They have a good head of audiology who is proactive and pushes
the department, seeks more funds, is active within the trust.
They do not have any vacancies. They had posts cut but those posts
have been restored. They are up to full strength and they are
a well-resourced department doing a good job. In many parts of
the county posts are frozen. The numbers on the establishment
are not sufficient anyway. We have qualified people coming out,
but from last year 40% still do not have a job. We have heard
that the NHS is reducing the number of places on these courses
they are commissioning, because the people coming out are not
getting jobs, even though we need to boost the capacity in the
NHS by 50% or 60% or 70%.
Q26 Dr Stoate: It is only about money
really. You are saying that the capacity exists in terms of numbers
of people coming through the system; it is just a matter of hospitals
having the money to employ them.
Dr Low: It is not just that but
that is a core issue.
Q27 Dr Stoate: That would pretty much
deal with it.
Dr Low: I do not believe it would
deal with it. If we need to increase the capacity by, say, 50%,
that is a very large number. That may be an extra 800,000-900,000
audiologists. We are not going to get them in one year.
Q28 Dr Stoate: That could not happen.
Even if hospitals employed everyone available, there still would
not be enough capacity.
Dr Low: Correct.
Mr Murphy: Could I answer the
question that was asked before on the 18 weeks. I think there
are two issues. First, the 18 weeks is difficult to measure because
it is not consultant led, so the audiology is not measured from
the 18-week waiting list targets. Secondly, Ruth mentioned the
Cinderella service. Audiology is delivered in acute hospitals
and by very definition will not get the priorities. Until that
changes, I think the 18-week waiting list is a mammoth target
to try to achieve. On skill mix, I would call it a re-engineering
of skills. If that happens in the independent sector, it would
increase capacity significantly, and we have put forward proposals
on that.
Q29 Dr Taylor: Knowing GPs and Howard
referred to the consultant, is there not then a wait from the
consultant to the fitting of the aid?
Mrs Thomsen: The 18-week wait
was a statutory one: for complex cases, treatment by December
2008. This is from referral to ENT to treatment, and the treatment
would be classed as a hearing aid fitting.
Q30 Dr Taylor: So that is an absolute
way of getting around it.
Mrs Thomsen: Yes—but do
not tell anybody.
Dr Stoate: Welcome to my world.
Q31 Chairman: You are saying that
a hearing test is treatment.
Mrs Thomsen: No, the hearing aid
fitting is the treatment. The hearing test is the diagnostic test.
Generally, on their visit with ENT, the treatment is the fitting.
Q32 Dr Taylor: So if people are listening
to this—and it is being broadcast—we are going to
bring the whole ENT service to a halt by these referrals.
Dr Low: To be fair—not that
I speak on behalf of Government—they recognised that. The
whole point of this plan is that there was anxiety that the 18-week
target, that whole scheme, is likely to fall into disrepute and
fail because ENT will be swamped with patients and will fail to
meet the target and people will say, "There is a target set
and we did not even meet it." There is an understanding that
that is exactly what will happen if there is not a robust plan
in place.
Q33 Dr Taylor: I am sure we will
be tackling the Minister on the 18-week target in detail. Moving
on, we have talked quite a bit about Modernising Hearing Aid Services
already and I am absolutely delighted to hear you, Ruth, say it
has been fantastic. Is that so across the whole country? We have
heard yours is an outstanding department. Has it helped the less
outstanding departments, the run-of-the-mill ones?
Dr Low: Every single audiology
department, every outreach clinic was modernised over the period
from 2000-05. Every member of staff was trained, digital hearing
aids became the standard and those have improved in quality over
the time. The purchasing agency at the NHS has done a good job
of putting a contract in place which is escalating the technology
as it becomes available. So, yes, it is universal. The evidence
that we had at the time we were involved with the Department of
Health, showed that those departments that had long waits before
the modernisation were the ones which had problems afterwards
and the good ones before, like Charing Cross, were the ones which
performed to the highest level afterwards.
Q34 Dr Taylor: It was phased in,
was it not?
Dr Low: That is correct.
Q35 Dr Taylor: We were one of the
lately affected areas and so I had lots of complaints then. To
be fair, I have not had complaints about it really since. That
was a success as far as it went. Obviously, as these digital hearing
aids became more and more widely used and their effect and their
benefits were appreciated, there was a tremendous surge in demand.
Should that have been forecast and action taken to prepare for
that demand?
Dr Low: We are very fortunate
in this country because the MRC have some excellent epidemiologists
in hearing and audiology. They have predicted that in the UK about
two million people have a hearing aid and six to six and a half
million would benefit immediately from having one. There are other
people with hearing loss who might not fit into that.
Q36 Dr Taylor: Two million with and
six and a half million who still need them?
Dr Low: No, in total. There are
another four to four and a half million to go. If you are getting
a poor quality hearing aid that is not working very well and everybody
knows that, you are not going to bother going to your GP. If you
have a friend who has a nice, modern, digital hearing aid and
you are aware when you speak to them that they are communicating
well, you will think, "Maybe it is time for me to go and
do something about it." So, yes, absolutely, there will be
a surge in demand, and the epidemiology predicted it.
Q37 Dr Taylor: One thing I have always
wanted to know and maybe Mr Murphy can answer, is however it was
possible to reduce the price from £2,000 to about £70?
Mr Murphy: First of all, I do
not know where the price of £2,000 came from. The average
price for a hearing aid in the private sector is just over £1,000.
Q38 Dr Taylor: Some of my constituents
at that time were quoted £1,700 or that sort of figure. At
£70 each, is industry covering its costs or are these loss
leaders?
Mr Murphy: The £70 is the
price direct from the manufacturer. At one stage we are talking
about a retail price and at another stage we are talking about
a manufactured price.
Q39 Sandra Gidley: Why is there such
a mark-up?
Mr Murphy: It is not a mark-up
as such. The hearing aids that are £70, we pay in excess
of £300 for. The mark-up is not £70 to £1,100.
Most of the cost of dispensing the hearing aid is service. If
we could buy hearing aids at £70 or whatever the price was,
our prices would come down immediately on the high street.
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