The Fight to Retain Hospital NHS Adult Hearing Aid Services

In this blog I am referring to the service in England, accepting that it may resonate with other home countries and that we may all learn from a wider exploration of what is best in each.

Let me first ask a question:

In the future - should NHS Adult Hearing Aid Services be delivered primarily by Hospital based Audiology Services?

And answer it:

Yes, unequivocally. Hospital based Audiology Services should be the prime provider and the bedrock of the service for routine, complex, adult, and paediatric hearing aid services.

I say that because:

·       There already exist facilities, infrastructure, workforce, considerable experience of the widest service offer, and collaboration between different aspects of the service.

·       Collaboration between different aspects of the service (specialist services, hearing therapy etc.) enhances quality, clinician experience of unusual presentations and ultimately leads to a better patient experience as they are seen within one joined up service.

·       We need a career structure where those starting in NHS Audiology gain massive early career experience of adult hearing aid services whilst being exposed to the widest audiology portfolio and deciding on specialisation as part of a career plan.

·       We are good at it and the patients tell us so.

 

This is currently threatened.

There is already a mixed service offer in terms of traditional and commercial AQP Providers. The current COVID crisis has generated a backlog for many, and we should be asked to step up our capacity to meet demand. How many of us can do that? We also know that nationally (and it is our experience locally) that there has never been a plan that links commissioned activity with the demand that we know is out there - the numbers that we must be able to help given the opportunity.

This could be a series of blogs in which I set out my thinking, but I believe it is already clear that we need coordinated action, or we are doomed to lose the routine service to commercial providers.

Why?

There is muddled and inequitable commissioning, but I argue that we are complicit in this and ultimately it will be our downfall. We can game tariffs, cry ‘Complex’ for anything non AQP but where commissioners examine that closely for hearing aid services several high-profile Trusts have said ‘no thank you’ to the provision of routine adult hearing aid services. We must stop this happening.

What is it that allows for an outcome where hospital services are not commissioned but commercial providers are instead?

The stark reality is COST. Even with commercial providers taking profit from the hearing aid pathway (and we should assume that is significant given that it continues) it works out more cost effective than continuation of that part of the service within the Trust.

How can that be?

The settlement with the commissioners for audiology services is an explicit amount given to the Trust. Sadly, often, this explicit annual amount in no way reflects the audiology budget or the amount spent annually by the Trust on audiology. It is spent on other things. So, it is a busted comparison.

Hospital audiology appears expensive because for the contracted money (some of which is spent on audiology), more can be achieved by commercial providers even after taking profit. You can’t win! We were unhappy that there was the investment in the advent of AQP services when more could have been achieved by investing in the core service. But could it, when the system mitigates against that money reaching audiology?

How do you win?

The lesson that we have learned as a Social Enterprise over our first 11 years are many. These could be expanded on in further offerings, but I will cite the main one:

We are contracted directly to provide NHS audiology services with an explicit financial contract to achieve explicit KPI in terms of capacity and quality. We are not for profit, so now that we are incentivised to be efficient, any surplus MUST by law be spent on the service NOT on other parts of the NHS. I view this as an honest arrangement and significantly (and justly) challenges us with upping our game to compete.

The result – we sit somewhere between traditional hospital audiology services and the commercial providers. We are on NHS terms and conditions and other than more freedom to act, resemble a hospital-based service (we are based in the hospital). We are financially competitive and from our experience come top of the current league table in terms of value for NHS Audiology commissioning spend for adult hearing aid services:

1.Social Enterprise – must be as efficient as:

2.Commercial Providers

3. Trust commissioned audiology services (because the contractual settlement is not spent on audiology).

 

We are where we are – there is a mixed economy of providers. Give us back control and collectively we can plan the future – decide how much commercial help is needed in the short term and then capacity plan to get the best service for the money in the longer term – that should mean significant growth in our own services.

I do think we need to stand up and fight for what we believe in - protecting the assigned funding on audiology services to be spent on audiology patients. Collaborate, join forces, be directly commissioned, and determine the future. Work with the new Integrated Care System to achieve this. I am not (as some are) advocating here for an Australian system that disentitles large proportions of the population.

Free us to compete for the sake of the patients that we serve.

Happy to receive comments and debate. I will expand on aspects in articles to follow, for example about the offer of commercial services to bolster NHS audiology budgets (not lose them to profit).

 

Jonathan Parsons is a Consultant Clinical Scientist and Managing Director of Chime Social Enterprise - the NHS provider of Audiology Services in Exeter and East Devon since 2011, and Prime Providers since 2019 without AQP. jonathan.parsons@nhs.net