HC 1048-III Health CommitteeWritten evidence from Action on Hearing Loss (PH 91)

1. Action on Hearing Loss is the new name for RNID. We're the charity working for a world where hearing loss doesn’t limit or label people, where tinnitus is silenced – and where people value and look after their hearing.

We want:

people to acknowledge their hearing loss and take action;

more support for people with hearing loss;

no one to be isolated through their hearing loss;

people to protect themselves against hearing loss and tinnitus; and

to cure hearing loss and tinnitus.

Summary

Hearing loss is widespread, and demands urgent action.

Hearing loss can impact on health, wellbeing and employment.

Noise induced hearing loss is preventable.

On average, there is a 10-year delay in people seeking help with their hearing loss.

Diagnosis of hearing loss in adults is opportunistic and ad hoc.

There is a lack of integration between health and social care for hearing loss.

Poor access to health services for people with hearing loss causes health inequalities.

We are Calling For:

Hearing loss to be put on the public health agenda of Public Health England, Health and Wellbeing boards, joint strategic needs assessments (JSNAS) and joint health and wellbeing strategies.

Public Health England to consider a strategy to encourage people to take steps to protect their hearing.

Early diagnosis and management of hearing loss to be actively encouraged and promoted.

JSNAs to be refreshed to recognise and tackle the high levels of unmet need around hearing loss.

A full range of clinical expertise to be integrated into the commissioning process for hearing services.

Best practice in hearing service provision to be promoted and publicised.

Health services to improve accessibility for people with hearing loss.

A duty on local authorities to tackle inequalities.

Common boundaries between consortia and local authorities.

An efficient and effective local public health intelligence network.

Hearing Loss is Widespread, and Demands Urgent Action

2. Hearing loss is widespread. It currently affects more than 10 million people in the UK—or one in six of the population. Because of the ageing population, the number of people with hearing loss is set to grow by 14% every 10 years and by 2031 there will be approximately 14.5 million people with hearing loss in the UK. As such, it is a major and growing public health issue.

Hearing Loss can Impact on Health, Wellbeing and Employment

3. People with hearing loss frequently suffer from other additional disabilities or long term health condition that limits their daily activities, such as arthritis and mobility problems. This includes around half of all people with age-related hearing loss. This often compounds barriers to inclusion and feelings of isolation, and means that managing hearing loss can be fundamental to effective management of other conditions.

4. Research reveals that people with hearing loss have a higher prevalence of depression, anxiety and stress. A recent study shows that older people with hearing loss are 2.45 times more likely to develop depression than those without hearing loss.

5. Recent research also shows that people with mild hearing loss have nearly twice the chance of developing dementia compared to people with normal hearing. The risk increases threefold for those with moderate and fivefold for severe hearing loss.

6. Research we conducted in 2007 into the employment experiences of severely and profoundly deaf people, found that at a time of near full employment, deaf people were four times more likely to be unemployed than the general population, with negative attitudes from employers seen as the main barrier to getting a job.

Noise-induced Hearing Loss is Preventable

7. Noise-induced hearing loss is a preventable condition. Four million young people are putting their hearing at risk through their listening habits (including their use of MP3 players and going to music events), but the government does not provide public health information that allows audiences to make an informed choice about the dangers of overexposure to excessive noise.

On Average, there is a 10-Year Delay in People Seeking Help with Their Hearing Loss

8. Early diagnosis and intervention is fundamental to preventing and reducing the impact of hearing loss, supporting independence and wellbeing and preventing mental ill health. However, on average, there is a 10-year delay in people seeking help with their hearing loss. In a 2010 YouGov poll four in five people (79%) said that the NHS needs to make early diagnosis a priority for hearing loss.

Diagnosis of Hearing Loss in Adults is Opportunistic and Ad Hoc

9. Evidence suggests that GPs fail to refer 45% of people reporting hearing problems for any intervention, such as a referral for a hearing test or hearing aids. This raises concerns that GPs do not have up to date information around the importance of early intervention in guaranteeing positive outcomes for patients with hearing loss.

There is a Lack of Integration between Health and Social Care for Hearing Loss

10. Even when hearing tests and hearing aids are taken up, without the necessary ongoing social support people with hearing loss remain at risk of declining independence and wellbeing. Despite this, essential services such as lipreading classes, hearing therapy and assistive technologies for the home are under-recognised. Only one in five audiology departments provide patients with information regarding ongoing services and support.

Poor Access to Health Services for People with Hearing Loss causes Health Inequalities

11. Currently many people with hearing loss experience difficulties accessing health services and public health information that could enable them to manage their health effectively. This is due to difficulties accessing appointment systems and health settings and difficulties communicating with healthcare staff. Our survey about access to GP surgeries found a third of respondents with hearing loss have been left unclear about their condition because of communication problems with their GP or nurse and over a quarter (28%) found it difficult to contact their GP surgery to get an appointment because of their hearing loss.

We are Calling For:

Hearing loss to be put on the public health agenda of Public Health England, health and wellbeing boards, JSNAs and joint health and wellbeing strategies

12. Although it is clearly a public health issue that demands action, hearing loss is not currently on the public health agenda. We recommend that, with the creation of Public Health England, hearing loss is recognised and responded to through health and wellbeing boards, joint strategic needs assessments and joint health and wellbeing strategies.

13. A public health strategy should also take into account the effects of tinnitus (the perception of sound in the ears in the absence of external noise). Tinnitus can lead to sleep difficulties, and concentration difficulties in both social and employment situations. It also contributes to mental health issues. People with tinnitus need a range of information and support, from basic information and reassurance to intervention by clinical specialists and follow up care.

Public Health England to consider a strategy to encourage people to take steps to protect their hearing

14. Noise-induced hearing loss is preventable—Public Health England should consider a strategy to encourage people to take steps to protect their hearing.

Early diagnosis and management of hearing loss to be actively encouraged and promoted

15. As the core function of public health is to tackle determinants of health and wellbeing, people should be actively encouraged to address the onset of hearing loss, so as to avoid related conditions including depression, anxiety, dementia and social isolation.

16. We recently commissioned a cost benefit analysis of a hearing screening programme, which showed that the benefits of hearing screening for older people clearly outweigh the costs. At a cost of £255 million over 10 years, a hearing screening programme for over 65s could save £2 billion, representing a benefit cost ratio of more than eight to one.

17. As well as providing economic benefits, a screening programme would set out clear routes for referral and treatment for adults. This would ensure earlier and increased take-up of hearing aids, leading to more successful patient outcomes. It would also tackle the high level of unmet need and social stigma around hearing loss.

18. In the meantime we are calling for accessible and joined up hearing services delivered close to people’s homes.

19. GPs have an important role and should recognise the importance of early intervention and provide timely referral to audiology and hearing services.

20. We are calling on health professionals to develop Quality and Outcomes Framework (QOF) indicators, to provide an incentive for promoting hearing checks, and to integrate hearing checks into other routine health assessments, particularly those targeting older people.

JSNAs to be refreshed to recognise and tackle the high levels of unmet need around hearing loss

21. The white paper envisages health and wellbeing boards developing joint strategies based on the assessment of need outlined in their Joint Strategic Needs Assessment (JSNA). Making population assessments around hearing loss is complicated by the current levels of unmet need. Issues of stigma and inbuilt barriers to services mean that one in three people who could benefit from hearing aids currently do not use them.

22. JSNAs need to account for the one in six in the population who have some level of hearing loss. They should recognise the need for accessible services that would encourage those with hearing loss to access hearing checks and hearing aids. JSNAs also need to account for those with hearing aids who may need to receive ongoing social support to ensure hearing aids are fully utilised. This could be through services such as our Hear to Help, as well as lipreading classes and hearing therapy to help maintain communication skills, independence and wellbeing.

23. We recommend that JSNAs are refreshed to help tackle unaddressed need and ensure a joined up patient journey for people, and to promote prevention, early intervention, accessible services and ongoing social support for people with hearing loss.

A full range of clinical expertise to be integrated into the commissioning process for hearing services

24. It is essential that the full range of clinical expertise is integrated into the commissioning process for hearing services. This is of particular concern, as evidence suggests a lack of GP awareness around treatment options, additional services and referral criteria in audiology.

Best practice in hearing service provision to be promoted and publicised

25. We recommend audiology and hearing loss champions within each local authority, responsible for capturing relevant developments in technology, clinical procedures and models of service delivery. They would promote and publicise best practice in terms of hearing service provision and should be involved in the commissioning process.

26. We would also like to see some GP consortia becoming centres of excellence in specialised areas, including audiology and hearing loss, with the NHS Commissioning Board playing a fundamental role in identifying and disseminating good practice.

Health services to improve accessibility for people with hearing loss

27. Health services must commit to making services 100% accessible to patients with hearing loss. This means ensuring appointments can be booked not just on the phone but by email, text or text-to-speech relay services, ensuring that staff are all fully deaf aware and providing timely access to interpreters where required.

A duty on local authorities to tackle inequalities

28. Although the Health and Social Care Bill introduces important new duties on the NHS Commissioning Board and consortia to tackle inequalities in health, there are no equivalent duties on local authorities. This duty should be introduced to go along with the shift of budgets and responsibility for public health.

Common boundaries between consortia and local authorities

29. GP commissioning boundaries should, as far as possible, be aligned to local authority boundaries to support joint working between health and social care needs and to ensure population health issues are addressed, including tackling health inequalities and the needs of unregistered patients.

An efficient and effective local public health intelligence network

30. If the function of the Public Health Observatories is bought under Public Health England to save money, this should not be at the expense of a less effective local public health intelligence network, as this could result in higher overall costs. The role of the Public Health Observatories will also be complicated by the issue of co-terminosity between GP consortia and local authorities. The fact that these bodies have different catchment areas will make it more difficult to capture data to inform health and wellbeing boards.

June 2011

Prepared 28th November 2011