Examination of Witnesses (Questions 100-114)
DR JOHN
LOW, MRS
RUTH THOMSEN
AND MR
JEFFREY MURPHY
8 MARCH 2007
Q100 Sandra Gidley: Were you able
to charge for those services?
Mrs Thomsen: No. It is a very
special contract. We said, "Let's have some rent, then. Let's
income generate" because we are always told to do that, and
we were told that it was not on the table, it was not an area
on which we could negotiate.
Q101 Sandra Gidley: Would you like
to comment, Mr Murphy?
Mr Murphy: I have no knowledge
and I am quite surprised by what you are asking. We never experienced
any of that. Every patient went through our private branches.
We never went into the hospital. We had no costs to the hospital
at all. In fact, at the end of the story, we probably subsidised
the whole thing anyway, because we never got our investment back,
but we had no experience of difficulty finding property. We have
120 branches in the UK anyway and 90% of the population were within
our branches, so I cannot comment. I have no experience of that
at all.
Mrs Thomsen: I can imagine it
would also be a problem in high cost areas.
Q102 Sandra Gidley: Clearly it would
be something to watch out for and maybe specify in future contracts.
Mrs Thomsen: Absolutely.
Q103 Sandra Gidley: Presumably you
will be bidding for the new contracts when they come up. You said
you had not recouped your investment yet, so is this an opportunity?
Mr Murphy: Yes. We would like
to bid and try to recover our investment.
Q104 Sandra Gidley: That is fair
enough. We have had some evidence from opticians groups who seem
to be trying to muscle in on the act—I am not quite sure
why. They have said that if private companies are only used short
term to get rid of the backlog then this is just a short-term
fix, in effect, and they would need to be involved longer term
because the problem will recur. What is your comment on that statement?
Mr Murphy: There is a short-term
fix if the waiting list was dealt with as a block to get rid of
the hump. I think private companies and private contractors would
scale up and invest to do that. If you want my opinion, I think
it would create more demand. I do not think it does go away. I
think the hard of hearing, once they realise there is a good service,
will respond to it. I think the evidence was with the PPP. With
the first contract, we talked about 30,000 patients, but when
we got there it ended up to be 60,000 because the demand was there
from the audiology departments, the demand was there from the
clients. Short-term large movements of the waiting list are financially
sustainable if the contract is at the right price and it is at
the right length of time where you could scale up and get a return
on investment, but, going forward, I think the demand will always
be there. It will create more demand. Between the NHS with investment
in audiologists and ourselves with investment in private procurement,
I think that is the answer, and that is the long-term answer.
Optical companies probably think it is close to spectacle provision.
I do not think it is, but that is probably why they are making
the submissions. I think we would welcome any type of contractor
that would have capacity and could deal with the contract, why
would the Department of Health not welcome that as well? I am
sitting here thinking that I do not see an issue with anybody
who could fit the compliance level, could meet the targets and
could meet the contractual issues. If they are bona fide
and are selected, that is okay.
Q105 Sandra Gidley: Is it a case
that if there is no promise of continued involvement, then that
is a disincentive to investment?
Mr Murphy: Yes. Depending on the
length of the contract, people would scale up, and then if there
could be a return on the investment, yes, there would be people
out there. I think that is the key: there has to be a return on
the investment. We learned that through the PPP. There is investment.
It does not come free. There are investments in staff, property,
software, hardware and if the contract was of a certain size you
could get a return on investment there would be an appetite from
commercial organisations to try to win that contract.
Dr Low: I would like to point
out that this is not just a bulge; we do not have a one-off problem
that needs to be fixed. Demographics are changing so we know that
the number of people presenting is increasing but also, there
is this huge unmet need and, as the waiting times come down, we
know more people will present. There are 4.5 million people who
do not have a hearing aid today who could benefit from one. So
there may be a bulge but it is a small one. There is an ongoing
problem. There is an interesting debate to be had about where
audiology services, hearing aid services, should be delivered
from in the long term. Many people have the view that it would
be better delivered in a relationship like optics rather than
the current arrangement, where it is done in acute hospitals.
As I say, from my own point of view, I do not mind where people
are fitted provided they are fitted well and in a safe environment
but the optical industry has a vision and many in the private
sector have a vision that they would like to see the same thing
happen with hearing aids as happened with optics.
Q106 Sandra Gidley: Looking at a
graph provided by the Department of Health, it was very flat-line
up until the advent of digital hearing aids. That bulge seems
to be partly accounted for by the transfer and it does seem to
be flattening out again but at a higher level. Is it the case
that more people are coming forward because something is better?
Do people not realise they are deaf, in fact?
Dr Low: Yes, there are many people
who just do not acknowledge that they have a hearing problem.
The issue of denial is enormous. The people who suffer, if I can
use the word, are often the partners, the family and the work
colleagues rather than the individual themselves. It is when the
TV is blasting away. You know your diagnostic techniques are not
very sophisticated. There is a huge unmet need and a denial, and
the stigma has not gone away: "I am old, I am decrepit, I
now have a hearing aid," whereas we accept reading glasses
in our forties is just part of ageing and we get on with life.
We are working hard, as are others, to change, this public health
campaign to change attitudes. We established a telephone test
so that people could test their hearing on the telephone.
Q107 Sandra Gidley: I have done it.
Dr Low: That is just to try and
encourage people to think about their hearing and to take better
care of all of their health, not just the bits that are popular.
Q108 Sandra Gidley: So really, we
need some sort of assessment of what the problems are going to
be in the future before we can plan the services.
Dr Low: I suspect the Department
of Health will be able to give you more evidence in that area
than I can.
Mrs Thomsen: Since we were modernised,
we collect patient information at the touch of a button. I can
tell you how many are waiting, how many are waiting for this,
I can divvy the information up however you want it. Every audiology
hearing aid centre has a computerised patient management system
now. That information is there. People just have to ask for it
and we can give it to them. I would also say that hearing loss
generally due to the ageing process is progressive and an awful
lot of direct access patients we get have a very mild loss that
is not helped by a hearing aid. We do not then say goodbye; we
often look at other areas in which we can counsel them and help
them through. It is not just about hearing aids. Again, it is
looking at the whole patient and their needs. If a patient did
not need a hearing aid but maybe could be benefiting from something
else, then we would look at that. It is not just about hearing
aids. Hearing aids are not like receiving glasses. They really
are not.
Q109 Dr Stoate: You talk about the
parallels with optical dispensing.
Mrs Thomsen: I do not!
Q110 Dr Stoate: That is the question
really. You would not agree therefore that there could be a system
whereby you go and get a prescription, like you can with your
optician, and then have that prescription filled by anybody, not
necessarily associated with the same firm. In other words, would
there be such a thing as a hearing prescription after an audiology
assessment which you could effectively get filled anywhere?
Mrs Thomsen: The basic hearing
test that you would get when you first come to a hearing aid centre
would be pure tone audiometry where we put little sounds in your
ear and find out what is the quietest sound you can hear. If that
is tested in a soundproof room, in the proper environment, using
the proper techniques, then that audiogram can be transferred
from A to B. It is not always done like that; if it is a busy
high street Specsavers shop or somewhere like that, then the soundproofing
has to be there as well. Therefore it needs to be viable to have
that there. The person doing the test needs to be ... It is a
subjective test. You are relying on the patient to tell you whether
they can hear it or not. Performing a hearing test is not like
sticking electrodes on and you have a measurement for an ECG.
Diagnostic audiology, a lot of the time, is subjective; you need
to be aware of the correct techniques in terms of testing and
coercing the information out of the patient in terms of the results.
Q111 Dr Stoate: Can I stop you there,
because my point is, could you envisage a situation where people
went for a properly skilled audiological assessment, on exactly
the lines you are saying, and effectively come away, having seen
a top audiologist, with a prescription saying this is what they
need and perhaps—I am not saying I agree with it—is
there a case to be made for saying "I have this prescription,
I can go to Jeffrey Murphy's company and have that prescription
filled"? Is that a realistic proposition or not?
Mrs Thomsen: I would not like
to see that happen.
Mr Murphy: It actually happens
in Germany and France ...
Q112 Chairman: That is a different
point, Ruth. Seeing it happen as opposed to being a realistic
prospect are two different issues.
Mrs Thomsen: I think the person
fitting the hearing aid needs to be educated to a decent level.
They still need to understand the whole basis of hearing aid provision.
The profession itself is so small, to start chopping it up into
little bits in terms of somebody does the test and somebody fits
the hearing aid—I have seen it work. I have worked in other
countries and I have seen it work there but they are all incredibly
bored.
Q113 Dr Stoate: But it certainly
happens with spectacles. Jeffrey, are you saying it could happen?
Mr Murphy: It happens in Germany,
it happens in France, it happens in Italy, it happens in most
of the Continent, where a prescription is issued by an ENT or
in France I think they have changed it to a general practitioner,
and then the client is free to go to whatever high street hearing
aid dispenser he or she wants to go to. The system certainly works
in Europe. From our point of view, we would welcome that system
in the UK.
Q114 Dr Stoate: It could happen and
people would get a good service?
Mr Murphy: Yes, and they get a
very good service on the Continent.
Chairman: Could I thank you. There are
two things I would like to say. First of all, the evidence that
has been referred to on several occasions has not yet been published
because this is a one-off inquiry. It will be on the website some
time next week. A report coming out of today's hearing is likely
to be after Easter. Could I thank all of you very much for coming
along and helping us with this short inquiry today.
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