The Department of Health and Social Care and NHS England have set out their plan for reforming the provision of elective care services in England.
The plan supports a pledge made by the Prime Minister to ensure that by 2029, 92% of patients go from referral to treatment within a standard 18-week target.
Our Director of Strategy, Crystal Rolfe, explains why it is urgent that audiology services are prioritised in this agenda.
Waiting lists are a huge problem across the NHS, with the latest figures showing that 7.5 million are currently waiting for elective care (scheduled treatments which are not time urgent) and that three million of these people have been waiting for longer than the 18 week-target.
This is bad for the patient, bad for the health service and causes problems for wider society, for example, by keeping people out of work.
But what should this mean for audiology services?
There is a clear and compelling case that audiology needs to be a priority area for investment and transformation.
Audiology in crisis
The NHS in England – like its counterparts in Scotland, Wales and Northern Ireland – has struggled to reduce waiting times, which built up during the Covid-19 pandemic.
This has been a clear issue in audiology services, which had long been neglected by the NHS and the Government.
In recent years, audiology services have faced significant simultaneous challenges due to staff shortages and inadequate funding to meet rising demand, with people from our community telling us of waits of two years to receive their hearing aids.
Audiology is currently one of the worst performing specialities for diagnostic tests across the NHS, with four in ten patients waiting longer than six weeks for an audiology assessment.
This needs to be seen in the context of the unmet need for audiology services. Hearing loss is currently underdiagnosed and undertreated. We know that of the estimated 8 million adults who could benefit from hearing aids, only around 2 million currently use them.
There is a broader failure across the NHS to even get patients into the audiology pathway.
Evidence suggests that many people delay seeking help for their hearing loss, and those who do visit their GP about hearing loss are not always referred on for the appropriate test. This is despite the fact that unaddressed hearing loss is linked with increased risk of a number of conditions including social isolation, depression and falls.
Improving the diagnosis and treatment of hearing loss through improving the audiology pathway presents a major opportunity to contribute to the NHS prevention agenda.
What is the Government proposing?
The headline initiative from the Government in its new plan is to expand the use of Community Diagnostic Centres (CDCs) to create new capacity.
CDCs provide a range of checks, scans and tests in a single location, aiming to move services out of hospital and closer to people’s homes, often improving patient experience.
At the moment, the 170 CDCs across England are only making a marginal impact on the provision of audiology services. Latest NHS England data shows that only 1.7% of audiology assessments are carried out in Community Diagnostic Centres.
The Government are proposing to extend the minimum standards for CDCs, so that they are open 12 hours a day, seven days a week, and they provide a minimum of ten straight-to-test pathways. This means that patients do not have to wait to see a consultant before having their diagnostic test.
The NHS’s new report says these straight-to-test pathways must focus on the diagnostic tests patients are waiting the longest for locally.
What do we want to see?
Whilst audiology and hearing health are featured in some of the case studies within the new NHS report, there are no firm details on how the NHS will solve the issue of access to audiology services.
And, because audiology is not a consultant-led speciality, it is not subject to the standard laid out the NHS constitution of 92% of patients receiving elective treatment within 18 weeks of referral – a key focus within the NHS’s new report.
However, we know that audiology is currently the worst performing diagnostic service.
We therefore think it vital that:
- Hearing tests and access to further treatment are made a core component of the new expanded CDC service, and that straight to test pathways for audiology diagnostic testing are enabled.
- NHS England reinstates collection and publication of the Referral to Treatment waiting time data for audiology services, Direct Access Audiology, to enable informed patient decisions and monitoring of service improvement.
- Audiology services are prioritised within the upcoming NHS 10-year plan.
- The NHS develops a robust workforce strategy for audiology to ensure services are adequately resourced to meet rising demand over time.
We will continue to work with stakeholders and NHS providers to bring much needed innovation into audiology services.
Changes to where audiology services are provided must be supported by changes to how they are provided. The way in which audiology services are provided hasn’t been reformed in decades, despite advances in technology.
We’ve already set out how this can change, and will argue that innovation needs to be considered as a key component of reducing waiting times for audiology services.
