EXECUTIVE SUMMARY

  There has been no use of the private sector in this area of NHS healthcare in Wales and consequently no distractions for service commissioners and NHS Audiologists. The Welsh Assembly Health Department have set relevant waiting time targets and there are growing signs that these are helping drive resources towards Audiology services at a local level without he need for dedicated national level funding. In Wales it has been left to local NHS professionals to manage capacity and deliver against targets unburdened by constraints or uncertainty. This is alloiwng NHS professionals to focus on the task in hand—delivery of high quality services that are accessible to our patients. It is interesting to note that with the correct targets and professional advisory structures there has been no need for a national Audiology action plan in Wales.

INTRODUCTION

  I write this memorandum as a Head of an Audiology service at an NHS Trust in Wales where we face similar challenges to our colleges in England. However, there are some differences in approach taken in the delivery of NHS services between England and Wales providing the opportunity to make some useful comparisons. I believe that this is true of Audiology services and that comparisons may be helpful in deliberations on the future of Audiology services in England. On this basis I will provide responses to the questions posed.

Whether accurate data on waiting times for audiology services are available?

  1. In Wales waiting time figures for first fitting of hearing aids have been published by the Assembly Government on a monthly basis since April 2006. [14]Crucially, the definition of waiting time was developed with the help of Audiologists on the Welsh Assembly Standing Specialist Advisory Group in Audiology. As a consequence the measure is robust and relevant. The chosen measure for Audiology relates to hearing aid fitting which is a key outcome/treatment following referral by GP and is clearly recognisable by patients. I understand that in England the focus is on diagnostic tests such as audiometry which is in itself not a health treatment or outcome and I would question its value.

Why audiology services appear to lag behind other specialties in respect of waiting times and access and how this can be addressed?

  2. In Wales the first waiting times targets for first fitting of hearing aids has been set at 36 weeks and is to be achieved by end March 2007. It is very likely that we will see the number of long waiters decline significantly in the coming weeks. By 2009 the target maximum waiting time for first fitting of a hearing aid in Wales will be 13 weeks, including those patients referred directly from their GP to Aduiologist. The key benefit of targets for our patients at a national and local level is that NHS Trust general management are highly motivated to reduce Audiology waiting times. Conversely, in the absence of relevant waiting times targets for hearing aid fitting (eg as in the case in England) it could be anticipated that it will prove challenging for Audiology services to secure resources in competition against those services that do have associated waiting time targets.

Whether the NHS has the capacity to treat the numbers of patients waiting?

  3. With relevant measures (see above) the introduction of Audiology targets tha are progressively more challenging over a period of three years should allow time for Trusts to manage demand and direct resources accordingly. However, an environment of uncertainty might be expected to hinder the acquisition and deployment of resources to match demand. In Wales the challenge has been clearly given to NHS services to deliver to target, there is no uncertainty over who is delivering services (private versus public providers) and the increase in NHS capacity can be achieved by marginal increases over existing NHS resources so allowing for a prompt and a potentially more efficient response (see below).

Whether enough new audiologists are being trained?

  4. I have no specific information on this matter. However, the potential strength of the NHS Audiology service lies in a mix of professionals and skills being available to efficiently manage the variety of needs of patients presenting to the NHS. Currently the career pathway to provide for such a mix of skills is incomplete—the Healthcare science career pathway is under development. In particular there is a need for training/education to support greater numbers of Associate Audiologists and very senior professional staff. Such additions would complement the new graduate Audiologists that are entering the workforce, provide for career development, improved staff retention and sustainable services.

How great a role the private sector should play in providing audiology services?

  5. I assume the motive for this question relates to providing for increased capacity to deliver Audiology services. In recent months I have reeived flyers from private healthcare companies (participating in the English NHS independent sector procurement programme) seeking to recruit from amongst NHS Audiologists. It is difficult to understand how this approach will increase capacity within the NHS, a case of robbing Peter to pay Paul.

  One obvious approach to increase capacity would be through an increase in NHS in-house capacity. The rationale is that such increases would be marginal (given that many overheads would remain unchanged through use of existing facilities and management) and therefore costs would be marginal (and modest). For the sake of ensuring efficient use of tax payers money I would assume that such comparative cost analysis of the alternative models would be performed prior to any use of the private sector, but has this been the case? Of course access (waiting) time is not the only measure of service quality and it is imperative that other quality assurance issues feature in the procurement of services (whether public or private providers) and that the same standards are applied to all providers.

RECOMMENDATIONS FOR ACTION

—    Adopt national waiting time targets for first fitting of hearing aids.

—    Before outsourcing to the private sctor appraise the comparative costs of different routes to increasing capacity to meet demand—ie, outsourcing to private sector providers versus increasing capacity of existing NHS providers.

—    Establishment of a standing multi-professional Audiology advisory group in England.

—    Adoption of national quality standards (currently under development) for adult Audiology services. This would allow for consideration of quality issues additional to waiting times when procuring NHS Audiology services.

—    Support for all elements of the Healthcare science career pathway to provide a mix of skills required to deliver NHS Audiology services.

John Day,

Head of Audiology, North East Wales NHS Trust

February 2007

http://www.statswales.wales.gov.uk/ReportFolders/ReportFolders.aspx