I was present at the Inquiry and felt I must write and record my input to the evidence regarding PPP from Ruth Thomsen representing Charing Cross Hospital.

  My role at David Ormerod Hearing Centres is that of Relationship Manager. I am an Audiologist by profession and worked in the NHS for 20 years before moving to the Independent Sector. My last post within the NHS was that of Project Lead for the Audiology element of Action On ENT, a Department of Health Project aimed at improving organisational practice within NHS Audiology Departments. This gave me a national picture of Audiology and through interaction with a large number of Audiology services throughout England I gained insight into the challenges faced by many Audiology departments in meeting the needs of their local population.

  At David Ormerod Hearing Centres, we have worked with 48 partner Trusts to deliver over 25,000 full patient journeys. During this time we have maintained excellent working relationships with NHS colleagues and provided a high quality and regularly audited patient service.

  I was surprised and disappointed to read the Charing Cross submission and hear what Ruth Thomsen said about the partnership. I have addressed each of the points raised and I have sent a copy to Ruth Thomsen for information.

  Experience from PPP has highlighted grave concerns with regard to all aspects of the service delivery. Including hidden expenses such as:

—  rent-free use of NHS treatment rooms (contractual issue)

David Ormerod Hearing Centres were allocated Hammersmith Hospital (Charing Cross) and it was disclosed to the NHS Trust and to the RNID at the time of allocation that we had no spare facilities in which we could offer PPP service in West London (this was a London issue and not typical of other PPP centres). The initial concept of PPP was to use spare capacity in the private sector. The NHS Trust offered DOHC the use of St Mary Abbots Hearing Aid centre on days that it was not used by the NHS staff—thus increasing the usage of this room and improving the efficiency of the facility that was at that time under used.

—  NHS support services

I am sure Ruth will agree that we had routine positive contact with the administration staff and the service ran very efficiently with little input from the NHS management or audiologists.

—  Inadequately trained staff

The allocated Hearing Aid Audiologist was fully registered and had the same MHAS training as NHS colleagues. The Trust did not raise any issues about the standard of work carried out which was subject to a detailed audit process.

—  Quality control issues (referrals into NHS as PPP performance unsatisfactory)

A defined process was followed that complied with the contractual obligations and observation of nationally accepted guidelines and local practice. No issues were identified.

All PPP patients were ultimately referred back to the Trust, the PPP journey was limited to hearing assessment, hearing aid fitting and follow-up. The on-going aftercare was not included in the PPP contract which meant that all patients would go back to the Trust for ongoing care.

In our experience of the Public Private Patients (PPP) Scheme, serious anomalies have arisen—in fact, even the transfer of basic, valuable and important existing patient information has been given low priority or in fact simply ignored as irrelevant.

The national roll out of the IT function for PPP governed the timeline for data transfer at Charing Cross. They chose to continue to sending us paper copies of all files. All data was returned at the conclusion of the contract on a CD and IT support was provided to assist in the integration of their main database. This contract ended on 25 October 2006 and there is no data outstanding.

5.5  During the PPP contracts the companies delivering Patient Journey services experienced recruitment and retention issues ... Company staff turnover was very high because of low job interest. This led to poor continuity of care.

One Hearing Aid Audiologist worked on this contract from the start and up to the final months when she finished for maternity leave. At this point another HAA took over the coverage. Both of these ladies thoroughly enjoyed PPP and are both continuing to work in this field.

5.7  In an attempt to protect vulnerable patients, PPP staff were provided with rent-free space and services within NHS audiology facilities. Because of contract restrictions, PPP staff were not allowed to contribute towards waiting time improvements when any particular PPP patient DNA. In a similar situation, an NHS staff member would have been re-allocated dynamically to contribute in other ways. An extra NHS audiologist in-house would have been a much more efficient use of space and money.

This is purely a contractual and data protection access issue—it could be over come (and has been in other Trusts) with contract amendments. With regard to "rent free space", I would re-iterate that we made it clear at the very beginning of the contract that we did not have a venue in the desired location and because of this, Charing Cross paid the lower of the two contract prices for each patient seen.

In conclusion I feel that PPP was a very successful project and I would have no hesitation in endorsing collaboration between the NHS and private sector.

  Many thanks for taking the time to read these comments in relation to the Audiology inquiry.

Heather Pitchford

Relationship Manager, David Ormerod Hearing Centres

March 2007