25 June 2019
Vital hearing aid services across England could be at risk because an overwhelming majority of Clinical Commissioning Groups (CCGs), the local bodies responsible for commissioning and paying for NHS services, do not have the “bare minimum” information needed to be effective, according to new research conducted by charity Action on Hearing Loss. The report also highlights the vast disparities in hearing aid provision across England.
The report, launched today and entitled Valuing Audiology: NHS Hearing Aid Services in England, was compiled using data from Freedom of Information (FOI) requests the charity sent to all 195 CCGs in England. Of those who responded in full, just 1 in 20 (5%) knew how much they are spending on audiology, how many hearing aids they are fitting, and whether patients are satisfied with what they are receiving.
Dr. Roger Wicks, Director of Policy and Campaigns at Action on Hearing Loss, said: “These results demonstrate an alarming lack of oversight and accountability on the part of CCGs, which are entrusted with providing healthcare local populations across England need.
“Without what seems to be the very fundamentals of evidence-based healthcare commissioning – the most obvious of which is rigorous data collection – 94.6% of CCGs are displaying a grave failure in basic budgetary and service management. Without data on how many people are being treated for hearing loss or on the quality of services, commissioning for audiology in many parts of England is being done through apparent guess work, and we fear that under pressure CCGs may well continue to see hearing aid services as a soft target for cuts.”
The charity actively campaigns against cuts to NHS hearing aid provision, and has successfully persuaded 14 out of 15 CCGs not to go ahead with proposed restrictions. The new report, however, has identified three CCGs that are currently deliberately choosing to restrict access to hearing aids. North Staffordshire CCG, Dorset CCG and Cambridgeshire & Peterborough CCG all require a high threshold of hearing loss before hearing aids are provided, which means that hearing aids are not provided to all those who would benefit from them. This is contrary to NICE guidance which states that provision of hearing aids should be based on need, not threshold alone.
Roger continued: “Such a systemic lack of oversight on hearing aid services sadly seems to demonstrate that CCGs are still not taking hearing loss and its wider health implications seriously. Hearing loss is linked to a significantly increased risk of dementia, isolation and other mental health problems.
“Hearing aids are a lifeline for people who use them, and are prohibitively expensive for the vast majority of people when bought privately. NHS hearing aids enable people with hearing loss to remain engaged with their families and their work life, and it’s vital that they remain available. Until CCGs take steps to collect fundamentally important data on the services they are commissioning, these services remain exposed to risk of cuts and rationing.”
The charity’s report lists a number of recommendations for CCGs, including at minimum collecting accurate data on audiology spend, access rates, number of hearing aid fittings, waiting times and outcome measures. It also calls on NHS England to stipulate that this data should be consistently collected and centrally published.
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Notes to editors
RNID is the national charity helping people living with deafness, tinnitus and hearing loss to live the life they choose. RNID enables them to take control of their lives and remove the barriers in their way, giving people support and care, developing technology and treatments, and campaigning for equality.
At the start of 2019 there were 195 Clinical Commissioning Groups (CCGs) in England. CCGs are the bodies responsible for commissioning and paying for NHS services. Out of these, 191 responded and 168 provided answers in an interpretable form on the questions about spending, fittings and patient outcome measures.
Only 1 in 20 (5%) possessed what we view as the bare minimum information needed to commission effective audiology services, i.e. how much they are spending; how many hearing aids they are fitting; and whether patients are satisfied with the service they are receiving.
Fewer than 1 in 3 (28%) had complete data on their adult audiology spend.
Just over 1 in 7 (15%) had complete data on how many hearing aids they were fitting to adults.
Fewer than 1 in 4 CCGs (24%) collected data on the full range of recommended patient outcome measures. Fewer than 1 in 5 (19%) of people with hearing loss have actually accessed an NHS audiology service in the past 3 years.
Three out of five (60%) of CCGs lack any kind of policy for implementing NICE guidance on hearing loss published last year.