I qualified as a Hearing Therapist and then as an Audiologist in 2004, and am currently practicing in the NHS at North Manchester General Hospital.

EXECUTIVE SUMMARY

  My basic concern is how any changes within Audiology Services may impact on patients, ie their independence, their quality of life and wellbeing—as well as the effects on their families. I am also extremely suspicious of attempts to somehow downgrade and cheapen Audiology as a profession and/or as a service. Some of the modernisation thinking we hear about is shockingly regressive. Instead of promoting quality of care it seems to suggest the priority for change should be based on reducing costs and the professional status of Audiologists. It implies the mentality of an accountant (knows the cost of everything but the value of nothing), rather than one which should be seeking to improve standards in quality of care.

  1.  As a team here in North Manchester, we have worked damned hard over the last few years rolling-out the digital hearing aid program. We even helped a neighbouring Audiology Department to do the same, in what was a huge effort to replace our patients' analogue aids with digital aids. Clearly, completing such a massive task takes time but our waiting list has been beaten, and for some time it has been down to zero.

  2.  Fitting new hearing aids to people, whether they be first-time users or those converting from analogue to digital, often involves overcoming a variety of technical, and personal, issues which patients bring to clinic. Anyone who thinks diagnosing and then simply fitting appropriate hearing aids to the many different people who attend audiology clinics, is very sadly, way off the mark.

  3.  By its nature, hearing impairment very often affects the aged, the vulnerable, the disabled, deaf/blind people. As a hearing therapist/audiologist, I am only too well aware that aural rehabilitation and support should never ever ever be underestimated or undervalued. To do so would demonstrate a total ignorance of what Audiology services should be really about. Being able to hear well, understanding the nature of your hearing loss, being aware and confident in strategies needed to employ with the use of hearing aids, being confident in the ongoing support (without delay and when it is needed)—these are basic patient requirements and should be intrinsic in everyday Audiology services. I would be extremely worried for all our patients, should audiology services be ruthlessly hived-off to the private sector—who whilst providing a good service to those people who chose that route, I feel are ill-placed to accommodate the complete patient-centred approach needed by NHS patients. These patients frequently have much different needs, in terms of lifestyle, dependence, confidence, capability, disability and so much more. I feel very strongly that NHS patients themselves would be totally against a move towards Private Sector care—and listening to patients should be uppermost.

  4.  Audiology Departments are, of course, involved with many procedures other than fitting hearing aids. For example at North Manchester we have welcomed an even closer working relationship with our colleagues in ENT, by fully embracing the Tier 2 strategy. Consequently, our ENT patients' appointments are now also scheduled and seen much quicker than was previously the case.

  5.  I strongly suspect we have sufficient Audiologists in the UK, especially with those currently coming through the graduate route. We should look to employ them in the NHS, take our profession forward, copy and standardise proven good practice and ignore calls to fragment what I feel is an essential lifeline to those millions of people in the UK needing our care. Proposals to for the private sector to take on NHS patients, which somehow are envisaged by only a few as being modernistic and the way forward (to resolve what is a temporary problem only, ie converting analogue to digital fittings), should be seen for what they really represent. An opportunistic strategy to reduce costs (which may ultimately be passed-on to patients anyway), and lower the profession status of our profession.

  6.  I refer to the voice of one with 32 years experience in both NHS and Private Sector Audiology Services, as quoted recently:

Dr David Reed—Chair of Education Committee for the British Society of Audiology

It is not obvious how the Independent Sector can deliver this service more effectively than the NHS. The NHS has lower fixed costs of accommodation and equipment and its staff costs are very competitive compared with private sector salaries. Since the NHS buys hundreds of thousands of hearing aids per year, it is able to buy at low unit cost due to volume discounts. In addition to lower costs, the NHS does not need to make a profit for its shareholders.

It would appear that the only way for the Independent Sector to compete on a level playing field with the NHS would be to employ staff that are paid less for their service and/or give less time to the patient. Professor Sue Hill used the analogy with the ambulance service which uses a number of NHS staff at band four or below. Band five equates to the BSc level Audiologist. So what is the prospect for the new graduate BSc Audiologists? Before they come into the work place their potential jobs are being down graded in the interests of improving the NHS?

European Countries have a BSc as their basic qualification to practice as Audiologists. In the United States we see that they have recognised the advancing science of Audiology and from next year their minimum qualification to practice will be a doctorate in Audiology.

Why is Sue Hill leading the UK Audiologists backwards and in isolation from our colleagues around the world? 2[2]

  7.  In conclusion—my own questions:

—  Why all the fuss, the analogue/digital conversion of patients' hearing aids will be completed in the not too distant future—what then?

—  The technical aspects of hearing aid prescription and fitting, whilst clearly important, are just part of the process of ensuring people can communicate to their best capability, why downgrade the profession in a cheap attempt to reduce waiting lists?

—  Why not look at the successes achieved, and widen/build on them?

—  How on earth do people expect qualified Audiologists and new graduate Audiologists to study for, work for and accept Band four salaries?

—  Should people who dream-up such things even have a voice on this important issue?

—  Hearing loss, if not treated sensitively and professionally, frequently isolates patients from family, friends and occupation. They loose their confidence, potential and can easily become increasingly reliant on other costly services. Audiology is not simply a technical fitting service. Aural rehabilitation and a holistic patient-centred approach is absolutely vital—and intrinsic in any reputable audiology service. Why should anyone with even the slightest regard for, or experience of, audiology patients think otherwise—unless for reasons of sheer basic economy?

Terry Allen

Audiology Department, North Manchester General Hospital

8 February 2007