EXECUTIVE SUMMARY

  This document is written by a group of NHS Audiologists representing the services in London. 15[15]

  The advent of NHS digital hearing aids in London has produced a great initial demand from new and existing users, leading to long waiting times for the service. This initial rush is now reducing to a manageable level. Departments are still facing great difficulties due to vacant posts being frozen and funding diverted away to help with Trust deficits. Many departments have been involved with the Private Patient Partnership Scheme but this has proved unsatisfactory further adding to the Audiology workload. When future use of the independent sector is considered there should be input from NHS Audiologists in order to ensure quality care.

  There is good communication between departments in the area and a willingness to work together looking at innovative ways of providing patient care. If the allotted resources reach the Audiology departments a high-class service can be provided to the customer with minimum delays.

  The RNID has always recognised that London Audiology departments and Audiologists have unique problems particular to the area due its socio-economic diversity.

  The authors all play a leading role in Audiology in the Region and volunteered at a recent Audiology Heads of Service meeting to represent Audiology in relation to recent developments such as the independent sector involvement within Audiology.

  Below are our views relating to the question raised by the Health Committee.

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

  1.  We have attended several meetings, both BAA National and Regional Meetings and London Heads of Department meetings where this point has been raised. There seems to be a great disparity between the interpretations of these figures. As such they cannot be compared across different Trusts. The wording is very ambiguous. To this extent the above people have been liaising with each other with the idea of standardising the data collection across the whole of London.

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

REASON FOR WAITING TIMES

  2.  The advent of digital Hearing aids brought additional monies for increased staffing at each centre throughout the region under the MHAS program. The problem at that time was there were not enough qualified staff to fill these posts. This led many departments having to use expensive locum staff for short periods rather than permanent staff on a long-term basis.

  3.  Traditionally Audiology has been seen as a poor relation in many hospital Trusts and therefore not given priority or adequate funding. With the advent of MHAS this improved but demand on our service also increased. With continued funding Audiology Services could be innovative and push the profession forward.

  4.  There was much publicity surrounding the introduction of digital hearing aids. This led many people to apply for them as soon as they were available. A typical Audiology Department such as at Chase Farm Hospital had approximately 22,000 patients registered with it on the paper system at the time of change over. There is therefore a very high demand for the first few years. This initial rush is now calming down. Each month there is now a manageable amount of referrals for upgrading to digital hearing aids.

  5.  Because the new hearing aids are better at giving targeted support to individual hearing losses, patients who would have been unaidable, with analogue aids, are now able to benefit from the improved technology.

  6.  Centralised ring fenced funds available during the MHAS programme and brokered by the RNID successfully reached Audiology services. However, since completion of the MHAS programme, money to maintain modernised services are no longer ring fenced. PCTs in many areas have failed to commit appropriate funds beyond the ring-fenced allocation, which has caused increased Audiology waiting times.

  7.  During the MHAS programme three waiting list initiatives were made available in an attempt to control the spike in referral rates to Audiology services. These were the Private Public Partnership (PPP) Scheme which used Private Dispensers under the NHS PASA framework to provide Audiology patient journeys; overtime access, which funded staff within core NHS services to offer "out of hours" services to provide additional patient journeys and the Hearing Direct Scheme, providing a trained telephone operated follow-up service as part of the Hearing Aid patient pathway. Audiology services were able to bid for a proportion of the funds available. The RNID controlled the allocation funds to meet the UK patient need. However since completion of the MHAS programme, money to maintain a modernised service and continue to make use of waiting list initiatives is no longer ring fenced. PCTs in many areas have failed to commit appropriate funds beyond the ring-fenced allocation, which have caused increased Audiology waiting times.

HOW CAN THIS BE ADDRESSED?

  8.  The initial rush for digital hearing aids is calming down. This will mean that in the near future many departments will have reduced demand for the digital service and just have to maintain demand. It should be noted that this is expected to be higher than before due to the fact that many people who would have not bothered to apply for an analogue aid would apply for a digital one since a greater degree of help can be given.

  9.  Skill mix. Many centres are still using highly skilled Audiologists to do semi technical jobs or clerical work. An associate level practitioner should undertake these. The Modernisation agency did a lot of useful work looking at the role of the Associate Audiologist. A funded Foundation degree course in Audiology could help to train more people at this level.

  10.  Including the fitting of hearing ads in the 18 week targets would give Audiology a higher profile within the Hospital Trusts and PCTs. This would ensure that appropriate funding reached the departments and wasn't diverted elsewhere.

  11.  Giving ring fenced monies to Audiology departments. If this was done for the next few years it would enable departments to have adequate resources to deal with the backlog analogue to digital waiting lists.

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

  12.  One of the problems many centres have experienced is having unfilled vacancies frozen or removed. This reduces that department's capacity and works against the MHAS program, which acknowledged that a digital service could not be delivered unless the staffing levels were increased.

  13.  The waiting list capacity initiatives supplied money to NHS Audiology to work extra hours and get paid per completed patient journey (At least three visits: Assessment, Hearing aid Fitting and Follow up). Many Audiologists took part in this scheme leading to an increase in capacity while maintaining the high MHAS standards. The cost per patient through this route was also significantly cheaper than through the PPP route. We believe that due to the success of this scheme it would be a worthwhile use of resources for it to continue rather than as a one off exercise.

Whether enough new audiologists are being trained?

  14.  As Chair of the Audiology sub group for the London Workforce Development Confederation Keith Dunmore has been looking into demand for Audiologists in London in relation to Audiologists being trained. As yet there are no definitive figures, but anecdotal evidence that Audiology departments are losing vacant posts due to their Trusts economic situation. This summer the first London graduates will be looking for positions and we will be monitoring their progress. A strong concern is that many of these young graduates will have to work in the independent sector fitting hearing aids. It should be noted that a qualified Audiologist role covers a wide range of duties including audio-vestibular diagnostics, balance rehabilitation, tinnitus assessment and management as well as paediatric diagnostics and rehabilitation. Most newly qualified Audiologists would not wish to work in the private sector due to very limited experience and workload that they would cover.

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

  15.  There is evidence that in London the PPP scheme was not a success. In March 2006 we gathered information from Audiologists in the region relating to their PPP schemes. These were presented to the All Parliamentary Group on Deafness. The main problem was that once the patient had been concluded their "journey", and obtained their hearing aid they very soon presented themselves at the NHS Audiology department as they were having problems. These often included very simple problems that should have been sorted at their initial PPP visit. Although the companies undertaking PPP agreed to work to MHAS standards most departments could provide evidence to the contrary. This was acknowledged by the companies who tried to solve the problems, but still led many patients to undergo a substandard experience.

  16.  Based on local experience only, the following observations have been made:

—    PPP was unable to provide commercially based care in our area due to the high cost of rental space.

—    A concerning lack of basic training was noted. Levels of training and education were not comparable with our existing NHS staff, and several near misses were identified which raised significant concerns regarding patient care.

—    Diagnostics, complex rehabilitation cases and paediatrics could not be addressed by the PPP initiative.

  17.  If the independent sector is to have further involvement then it is vital that the contract is drawn up with the advice of Audiologists with safeguards in to protect quality of the patient journey.

RECOMMENDATIONS FOR ACTION

—    Clarification/definition of Audiology waiting times.

—    NHS Audiology departments should receive their allotted funding in order for them to work at capacity and reduce waiting times.

—    Waiting lists for hearing aids should come under the 18week targets to ensure proper investment in the service from the PCTs.

—    The continuation of short-term waiting list initiative while Audiology departments clear the initial rush for digital hearing aids.

—    Pressure put on trusts to "unfreeze" Audiology vacancies.

—    NHS Audiologists should have input into any independent sector contracts to insure quality of patient care.

CONCLUSION

  18.  If the above points are taken in to consideration we believe that NHS Audiology in London can welcome and meet the challenges of providing a high quality patient service within a set timescale. In fact London services could work together to help neighbouring hospitals whose waiting times are outside the targets. We could welcome the chance to meet with you and further discuss these issues.

Keith Dunmore

Head of Audiology, Barnet and Chase Farm Hospitals NHS Trust

Terry Nunn

Acting Head of Audiology, Guys and St Thomas' NHS Trust

Pete Roberts

Head of Audiology, Ealing PCT, and

Julie Wilkins

Head of Audiology, Charing Cross Hospital

7 February 2007