EXECUTIVE SUMMARY

  The unacceptably long waiting times for audiology services would be resolved by financial flows resulting from publication of National Tariff for audiology in 2007-08. Audiology departments need to become more efficient and employ the audiology graduates now abundant. The current planning around independent sector provision is resulting in reducing NHS capacity and threatens long term care for hearing impaired adults and children.

INTRODUCTION

  I am Andy Phillips, Consultant Clinical Scientist and Head of Audiology Services for West Berkshire. I have been involved in audiology research, management and service provision for over 20 years. I was recently presented with a National Award for Service Innovation by the Secretary of State for Health. I am providing this evidence in a personal context, but have been involved in national discussions on Audiology Services for many years.

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

  1.  There is strong evidence that Audiology Services do not routinely collect data on numbers of patients waiting, consecutive number of days waited, referral rates or capacity. Data given by Trusts, therefore cannot accurately describe waiting times, and therefore the centrally collected data are inevitably inaccurate, a point conceded by DH on many occasions. With central planning blight, providers find it difficult to give patients an accurate estimate of their likely wait for a service. Recent application of targets has distorted service provision, for example, with services assessing patients within target waiting times, but patients having no possibility of being fitted with hearing aids since fitting is not associated with a target.

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

  2.  (a)  Audiology services are generally managed, led and provided by non-medical clinicians. Audiology services have in consequence, never been associated with waiting time targets. None of the National Service Frameworks mention hearing care. NHS managers are tasked with meeting targets and resources are, therefore, diverted away from audiology towards services that are associated with targets. Similarly, audiology is concerned with quality of life issues, rather than acute or chronic medical care, and the NHS is focused on life saving or prolonging treatments. In general, issues around care of the elderly receive disproportionately little funding.

   (b)  Until recently, there was a global shortage of qualified audiologists and so when resources were available, in some areas of the country, it was difficult to recruit. This shortage has now been resolved by DH investment into BSc Audiology courses.

   (c)  In common with much of the NHS, there is significant inefficiency and poor use of staff skills within NHS Audiology departments. Improvements are required, both in terms of quality and efficiency.

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

  3.  If audiology departments had adequate funding, they could recruit some of the excellent BSc audiology graduates into the workforce. With an average of an extra two wte new graduates employed per 500,000 population, together with wider use of Associate Practitioners, and efficiency improvements, the NHS would have the capacity to treat the numbers waiting. This issue would simply be resolved by changing the current "indicative" tariff for hearing aid episodes to "National Tariff" status. This would mandate Commissioners purchasing audiology care at an economic rate, which would allow NHS providers to recruit the small number of extra staff they need.

Whether enough new audiologists are being trained?

  4.  Currently, more than enough new audiologists are being trained. If MSc, PGDip and BSc graduates are included, there are around 300 new graduates produced at public expense per year. The issue is that audiology departments have not been able to secure the funding from their activity to allow recruitment of these new graduates.

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

  5.  The concept of patient choice and plurality of provision should be welcomed as it should lead to better quality of patient experience. However, this is not currently being planned appropriately. For example, the ring-fenced funding of 300,000 patient journeys, together with phase 2 ISTC provision is having the consequence of reduced NHS capacity. This results from NHS Audiology departments not being able to bid for this work.

  6.  Commissioners have a large sum of money that must be spent outside the NHS and are choosing not to commission NHS Audiology services from their baseline allocations. Value for money can only be achieved if both NHS and private sector organisations can bid for commissions on an equal basis. The danger with the current situation is that private providers may sell expensive private hearing aids to elderly, vulnerable patients instead of providing the free NHS devices. In addition, it must be recognised that patients fitted with hearing aids require lifelong maintenance over 20, 30 or more years.

  7.  If NHS capacity disappears, these elderly, vulnerable, often house bound patients may be forced to pay thousands of pounds for private hearing aids in order that they can be maintained. The training of private hearing aid dispensers is currently, and intended in the future, inadequate to deal with complex issues of hearing impaired people.

Andrew Phillips

Royal Berkshire NHS Foundation Trust

 [comments made as an individual]

4 February 2007