EXECUTIVE SUMMARY

  1.  The optical sector has been the field leader in delivering access, quality and choice for all in eye care, spectacles and contact lenses. The sector has delivered and trained its own high quality workforce to meet demand and established its own clinical governance, quality and regulatory frameworks to ensure consistently high standards to patients. As a result, quality and patient satisfaction rates in optics are extremely high.

  2.  Some optical providers also already provide hearing services. These and other providers stand ready to expand their services to meet demand and to take on much of the work currently causing long waiting lists in the NHS and distress for patients and carers.

  3.  All that is needed to bring this about is a speedy agreement about a partnership framework between providers and the NHS. We would argue this should be based on the optical model with an NHS prescription or voucher and agreement with the sector on costs. Using the readily available resource of optical practices in easily accessible locations, and building on their expertise in clinical quality and service to patients, must be a cost-effective way forward.

  4.  This could rapidly be put in place and, within months, could significantly expand audiology capacity in the UK. In the foreseeable future, this could lead to resolution of access and waiting times problems in audiology in the same way as it has in optics and to the same high standards of quality, access and patient service.

  5.  The optical bodies stand ready to enter into discussions with the Department of Health and NHS to bring this about. We would also welcome the opportunity to give oral evidence to the Committee to explain how we have achieved what we have achieved in optics and how these principles might rapidly be carried across into audiology to transform services for patients.

INTRODUCTION

  6.  This evidence is submitted by Professor Nick Bosanquet on behalf of the Association of British Dispensing Opticians (ABDO), the Association of Optometrists (AOP) and the Federation of Ophthalmic and Dispensing Opticians (FODO), some of whose members already provide hearing services and where capacity could be rapidly expanded to meet national demand.

  7.  FODO speaks on behalf of 70% of the UK optical market including the supermarkets, substantial high street companies such as Specsavers, Boots, Dollond & Aitchison, Vision Express and Scrivens, and mobile domiciliary providers such as Healthcall. The AOP represents optometrists in the UK many of whom run independent optical practices in the community. The ABDO similarly represents dispensing opticians (of which approximately 25% specialise in the fitting of contact lenses) many of whom also run community optical practices.

  8.  There are some 7,000 optical practices in the community in highly accessible, convenient locations close to where people live, work and shop.

PARTNERSHIP ROLE OF PRIVATE SECTOR

  9.  The Committee has expressed a particular interest in the issue of whether the private sector could expand its role in providing audiology services. We set our evidence in the context of the analysis that existing NHS services are already under severe strain and, without effective changes in the way that hearing aids are provided, cannot possibly meet either current or future demand. We concentrate therefore on three issues:

(a)  What has been the record of private/public partnership in opticians' services? Has this provided safe and effective services which have offered value for money for patients and the NHS? Is it a model that might be followed for audiology?

(b)  What has been the record so far in providing audiology services? Have companies been able to offer these services?

(c)  What is the scope for expansion in public/private partnership in providing care to patients in need of hearing aids?

SUCCESS OF THE OPTICAL MODEL

  10.  The optical sector has been the field leader in delivering access, quality and choice for all in eye care, spectacle and contact lenses.

  11.  The original intention at the start of the NHS was that sight testing should be carried out in hospital ophthalmology departments. There was a "temporary supplemental arrangement" for sight testing by opticians. 6[6] However, the opticians' service developed beyond this, partly as a result of lengthening waiting lists, and was ultimately recognised as a permanent part of the NHS under the Health Services & Public Health Act 1968, which made provision for General Ophthalmic Services of sight testing and supply of spectacles (administered like the General Medical and Pharmaceutical Services). In 1985 the dispensing function (supply of spectacles) was deregulated following which there has been intense competition in the optical market to the benefit of both patients and the NHS.

  12.  As a result there has been a rapid growth in the use of spectacles and contact lenses whilst clinical standards in sight testing have improved rapidly. Before 1985 the technology of sight-testing had shown little change for the previous 60 years. Since then there has been a rapid rise in standards with new technology improving the accuracy of sight testing and the ability of practitioners to detect conditions such as early glaucoma during the sight test examination. This provides a very early and effective low cost method of screening which benefits the health and well-being of the patient, preventing longer-term costs for the NHS. Empowering patients through the optical voucher scheme has also resulted in up-to-date developments in spectacles and contact lenses being made available far earlier than would otherwise have been the case.

  13.  The main focus of the NHS general ophthalmic services (GOS) until now has been on sight testing and the issue of spectacles. This partnership has involved the NHS purchase of eye tests for children, older people and at risk groups and the provision of vouchers for spectacles. The opticians have provided a highly regarded service from widespread and easily accessible locations.

  14.  The supply of NHS ophthalmic services through the private sector has ensured that NHS patients receive a high quality of care. The same service levels are delivered to NHS and private patients alike. Private sector funding of ophthalmic practices has enabled the NHS to benefit from high standards of equipment and clinical training in the delivery of NHS services to patients. This has also enabled the NHS to deliver ophthalmic services in an extremely cost-effective way.

  15.  As an indication of the high quality and highly reliable service provided by the optical model, last year there was only a very small number of complaints from 17.5 million consultations.

EXPANDED ROLE IN DELIVERING CARE OUTSIDE HOSPITAL

  16.  Following a recent government review, the government and representative bodies FODO, AOP and ABDO are now in discussions with the NHS about new contractual arrangements which would cover a wider range of eye care services in the community. This is intended not only to increase patient access and convenience but also to help tackle long waiting times and bottlenecks in hospital ophthalmology departments. This follows on successful pilot schemes for direct referral of patients with cataracts or glaucoma by optometrists. The first Report of the National Eye Care Steering Group has also contributed through its detailed definition of care pathways. Most recently the Department of Health has published a report on the development of local commissioning to provide the wider eye care service. It is recognized there is substantial unmet need for early diagnosis especially among older people and that it would be possible to use private/public partnership to offer a much more accessible service.

ENSURING QUALITY

  17.  The optical sector has been at the forefront of driving up standards and ensuring clinical and service quality. Notwithstanding world-beating innovations in product and quality control, the sector has also, on its own initiative and without public investment, developed a Code of Practice for all providers of domiciliary care as well as—recently—new optics specific standards for clinical governance (attached). The commitment to quality and patient service is what drives optical providers and on which their success depends. This has already read across into audiology.

WORKFORCE

  18.  The optical sector also has a successful track record in developing its own highly trained workforce to meet demand. Not only does it fund its own workforce training and development but, faced with potential shortfalls in recent years, has funded a new School of Optometry at Anglia Ruskin University, its own Dispensing College in Kent and optical conversion courses at Bradford. Unsurprisingly therefore there has been a substantial increase in numbers of qualified staff working in the service with increases between 2001 and 2006 of 7,500 to 9,200 for optometrists and 4,500 to 5,200 for dispensing opticians. There is an extensive competency and qualification programme developed by the regulator (the General Optical Council) informed by the profession.

WHAT HAS BEEN THE RECORD SO FAR IN PROVIDING AUDIOLOGY SERVICES? HAVE COMPANIES BEEN ABLE TO OFFER THESE SERVICES?

  19.  There has already been a development of services for testing hearing and fitting hearing aids involving a number of companies such as Boots, Scrivens, Specsavers and Healthcall. As in optics, the sector has shown itself very ready to respond in innovative ways to opportunities to improve services for patients.

  20.  After pilot schemes in Leeds and Shropshire the Department of Health has also contracted with David Ormerod Hearing Centres and Ultravox to fit hearing aids. So far these contracts have served 68,000 people. These contracts have recently been extended and in July 2006 Health Minister Lord Warner in a speech in the House of Lords spoke of the possible further extension of a similar type of service to procure an additional 300,000 patient pathways from the non-NHS sector from the early part of 2007. This procurement together with the wider Audiology Action Plan are still awaited. An additional 48,000 patient journeys by way of the second wave Independent Sector Treatment Centres have also been tendered for. However there is far more that could be done.

COULD OPTICIANS EXPAND THEIR ACTIVITIES IN AUDIOLOGY?

  21.  The answer is a resounding yes. There is good evidence of the need for more accessible services, especially for older people. The national Study of hearing carried out by the MRC estimated that 67% of the over 80s population in the UK have some form of moderate or severe hearing loss, ie 1.57 million people (Davies 2003). 7[7] FODO, AOP and ABDO members have already invested in audiology and could expand the number of patients served in months rather than years. The Committee will have received evidence from Specsavers about their potential role and other providers including Boots, Scrivens and Healthcall, independent optical practices and others are all willing to become more involved.

  22.  The practice whereby companies provide a duality of an optical and audiological function is already well established. Scrivens have been providing such a service within their practices for almost 50 years, have been providing a hearing aid service within Dollond & Aitchison for the past 15 years and also provide similar services in Ronald Brown Opticians, Conlons Opticians and Alton Murphy Opticians. Scrivens currently provides such a service from its 140 optical/hearing practices as well as a further 250 centres including its own high street stand-alone hearing centres, other optical outlets and health centres. Specsavers offer a hearing aid audiology service through 220 of their high street outlets at present and plan to expand this to more than 350 over the next two years.

  23.  Hearing care at Boots is operated by David Ormerod Hearing Centres (DOHC) who operate in 111 High Street Hearing Centres nationwide within Boots Opticians; with an additional 50 Hearing Centres operating in stand alone high street stores or from within NHS Audiology Departments. The Company also operates a nationwide domiciliary service through a second brand Advanced Hearing Services. DOHC has established a proven track record through the successful delivery of Public Private Partnership (PPP) to provide a high quality nationwide adult hearing aid audiology service in the community and on the high street.

  24.  Healthcall Optical and Hearing Services also operate a nationwide domiciliary eye care service for people who are unable to attend a fixed practice and a private hearing aid service for this group of patients. Their experience shows a high level of audiology need for housebound individuals which is not being met and does not appear in NHS statistics.

NEW PARTNERSHIP

  25.  All that is needed to bring about a quantum leap in service and quality is a speedy agreement on a partnership framework with the NHS. As in optics, a tried and tested method would involve an NHS prescription of a hearing aid and an agreement with the industry on costs. It could also provide for some choice in that the prescription could be used with any accredited supplier. The service could also be extended to those users with mobility problems. In optics FODO, AOP and ABDO members have already developed a dedicated service for housebound individuals ensuring that vulnerable individuals have much better access to eye care. It would be very possible to develop a similar service in audiology. At present many elderly housebound individuals go without hearing correction and many die before they get access to the service.

  26.  It is often alleged that non-NHS providers would be limited to patients with the least severe problems. This is not so in the case of audiology where a new partnership could involve better service for people with the most serious problems of access. Professor Ian Philp, the National Clinical Director for Older People, has recently stressed the importance of early intervention and assessment for a range of conditions including hearing.

GROWING DEMAND

  27.  The new partnership could also expand to serve the additional requirements which would arise from population ageing and the greater availability of the service. It is likely that some people are deterred by the length of waiting lists. It is vital that future partnership should be seen as a long term commitment to greater variety of supply and choice rather than a one off exercise for reducing waiting times. However, if taken forward only in this latter short term context, the problem will simply recur after a year or two whereas there is now an opportunity to solve the access problem once and for all.

RECOMMENDATION

  28.  FODO, AOP and ABDO members are ready to develop a partnership with the NHS which could deliver a better service within months. Using the readily available resource of optical practices in easily accessible locations, and building on their expertise in clinical quality and service to patients, must be a cost effective way forward for audiology. When the original programme was announced in February 2003 the press release was headed: "Digital hearing Aids available to all by April 2005". This clearly has not happened but a new private partnership could greatly improve access within months and make this a reality for patients, the NHS and government.

Professor Nick Bosanquet

Association of British Dispensing Opticians, the Association of Optometrists and the Federation of Ophthalmic and Dispensing Opticians

9 February 2007

7   Davies A (2003) A National Study of Hearing. MRC. Back