The National Committee of Professionals in Audiology (NCPA) has changed its name to United Kingdom Federation of Professionals in Hearing and Balance (UKFPHB) with effect from April 2006.

  The NCPA was set up in 1990 as an independent committee representing the interests of the entire range of professional groups active in the field of Audiology. Thus it has a unique status in that it can be said to be a voice for the whole Audiology profession. Each of the member organisations is represented by a single committee member who acts as link between the UKFPHB and their own professional organisation and provides a briefing about the activities of their own professional group at each meeting.

  The United Kingdom Federation of Professionals in Hearing and Balance is thus unusual in that it is very broad-based, consisting of representatives from the field of education as well as healthcare, from charities as well as professional bodies, from the private as well as the public sector.

  The primary aims of the UKFPHB are to provide a national forum for debate of professional issues, for the sharing of information and as a sounding board for new ideas. As UKFPHB represents all the associations it is able to view audiological issues from a wider perspective than may be possible in totally profession based organisations. It is therefore in a very good position to act as a channel of access between professional associations and the relevant government departments.

  UKFPHB will also, via working parties, produce position statements, guidelines and statements of best practice on a very wide range of issues, for example UNHS, lost/damaged hearing aids, classroom acoustics and service provision.

BELOW ARE THE UKFPHB RESPONSES TO YOUR INQUIRY

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

  1.  No. In the field of audiology there have been great concerns and no clarification as to what exactly audiology needs to report on for the DH. Data is therefore inaccurate and there is missing data. Not all Trusts are submitting data and some are making monthly entries and others bi-annual census. Trusts may know how many patients and how long they are waiting but this information is not standardised across the country. There is a lack of clarity as to what is to be current in regards to assessments. Waiting time lists may be available but it is not known whether they are correct with regard to clarity. What is perceived by "audiology service" ie is it a patient coming with a hearing problem; paediatric; adult; balance; internal referral?

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

  2.  Audiology, historically, has had a low profile and is chronically under funded and demand always exceeds capacity. There is a lack of appreciation of the long process of a diagnostic work-up and rehabilitation of the audio-vestibular patients, by the managers and referrers alike, and scanty knowledge about the existing audio-vestibular services among the referrers.

  3.  If a patient's waiting time is to do with time from referral to time of hearing aid fitment that will have so many stages along the way that it will not be time of referral to time of first appointment. There is also a question of capacity in terms of equipment (including sound proofing which is costly) and audiologists. There is also a gap between first appointment and hearing aid fitting when a child may need to be recalled two or three times to get definitive results before a hearing aid is prescribed. The nature of audiology work necessitates an initial appointment which sets off a string of activities which requires a first assessment and lots of tests either aetiological or instrumental.

  4.  The management of a particular case could be medical or rehabilitative. If it is rehabilitative management, this could take quite a long time. There would also be several follow up appointments so the care pathways may be longer than in other specialties.

  5.  A lot of audiology cases are chronic in both audiology and balance and for both adults and paediatric hence there are a large number of follow-ups. An audiology department has to deal with, not only new patients but also, a huge amount of follow-ups. Hearing aid patients remain under the care of Hearing Aid Department for the rest of their lives as there is nowhere else for them to go.

  6.  There is also the situation that audiology cases may need to tap into other departments such as ENT and Medical Physics and feedback is required from audiology from these other departments. This has an impact on waiting lists and times.

  7.  It is also understood that according to new arrangements audiology departments may be split between the central site and community work. This would mean that audiology staff may have to travel between the various sites and will therefore have less time to see patients. This could make the situation of waiting times worse.

  8.  If everything is put together within one audiology department it would make training, teaching, research, etc easier. The audiology service has been modernised which has meant that demand is higher. There are larger numbers of existing patients coming forward and a small increase in the number of new patients. The volume of patients sent to audiology is much higher than, say, ultrasound, echo-cardiography, endoscopy, etc.

  9.  There seems to be a lack of detailed information at a local level to enable intelligent service delivery and commissioning. One way of addressing these issues is by audiology coming into tariff and being unbundled from ENT so that departments get paid for the services they provide.

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

  10.  In some areas—no. What is meant by "treat" and to what standards? Whether they are following the guidelines, protocol and complete care pathways or just a click and fit service. The NHS would have the capacity only if the service structure is changed and more staff employed with an appropriate level of skill and competencies.

Whether enough new audiologists are being trained?

  11.  There are nine universities in the UK currently undertaking the BSc course in Audiology, seven of these are in England. The University of Manchester has been running the course for five years. Each university has 20 to 30 students per year but there is a large dropout rate. Around 190 students will complete the course and about 60% are getting jobs.

  12.  There is also a financial aspect in that there is a lack of money to enable Trusts to employ staff. A lot of Trusts have job freezes and posts have been lost. There is a lack of money for career development. There are not enough medically trained staff with appropriate levels of skills and competencies and a lack of training positions for junior medical staff.

  13.  There is only one postgraduate course in audiovestibular medicine in the UK, the MSc at the Institute of Child Health, UCL. There is no training in audiovestibular medicine at the medical undergraduate or postgraduate levels.

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

  14.  This needs to be discussed with the local services. Sometimes Trusts do not want an audiology department within their acute sector hospital so the audiology services go to an outside provider with an unknown specification. There is a role for audiology in the independent sector which should be regulated and quality assured. In terms of the independent sector within the NHS market this is up to the local health department to say how that partnership should work.

  15.  In Australia there is a system where all information is on a central database. It is difficult to beat in terms of quality assurance and knowing exactly what everybody in the service is doing.

  16.  There needs to be unified governance for how audiology is directed at the moment. There are different needs in the different audiology services that are provided.

Pauline Beesley

Chairman, UK Federation of Professionals in Hearing and Balance

5 February 2007

THE FOLLOWING ORGANISATIONS HAVE A SEAT ON THE UKFPHB COMMITTEE

BAA—British Academy of Audiology www.baaudiology.org

BAAP—British Association of Audiological Physicians www.baap.org.uk

BACDA—British Association of Community Doctors in Audiology www.bacda.org.uk

BAEA—British Association of Educational Audiologists www.educational-audiologists.org.uk

BAO-HNS—British Association of Otolaryngologists—Head & Neck Surgeons www.entuk.org

BATOD—British Association of Teachers of the Deaf www.batod.org.uk

BSHAA—British Society of Hearing Aid Audiologists www.bshaa.com

RCSLT—Royal College of Speech and Language Therapists www.rcslt.org.uk

BSA—British Society of Audiology

IN ADDITION TO THE ABOVE, FOUR OBSERVER ORGANISATIONS SIT ON THE COMMITTEE

DOH—Department of Health

NDCS—National Deaf Children's Society www.ndcs.org.uk

PASA—NHS Purchasing and Supply Agency www.pasa.nhs.uk

RNID—Royal National Institute for Deaf People www.rnid.org.uk