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At this time of change in the way services are commissioned within the NHS the British Academy of Audiology would like to work with commissioners to ensure quality services are available to all patients needing our professional services.


Commissioning Services for People with Hearing Loss: A Framework for Clinical Commissioning Groups

Commissioning Services for People with Hearing Loss: A Framework for Clinical Commissioning Groups is an online document that aims to offer CCGs clear guidance and evidence to aid informed commissioning decision making, with illustrations of what high quality cost-effective integrated care can do for local populations. Whilst responsibility for commissioning is at a local level this Framework also sends out a clear message about the importance of jointly tackling hearing loss to ensure that people can live independent lives with reduced risk from dementia and mental health problems related to communication difficulties. 

Read the framework online

This Framework was one of the many objectives identified in the Action Plan on Hearing Loss 2015 and has been designed to evolve over time so should be accessed online at https://www.england.nhs.uk/wp-content/uploads/2016/07/HLCF.pdf. 

BAA along with its partners in the Hearing Loss and Deafness Alliance co-produced these documents with NHS England and other health system stakeholders. Going forward we look towards continuing to work with NHS England on the next stages to not only ensure this document has impact across the whole hearing care system but also to develop strategies to address all objectives identified in the Action Plan on Hearing Loss.


Additional Documents


During the development of the Framework other documents were referenced and linked to. These documents relate to pathways and recommendations for more complex referrals around Tinnitus and Balance. These documents were produced by a multidisciplinary group representing a range of professional bodies with an interest in vestibular and tinnitus work within Audiology, and BSA agreed to host the documents on their website. The link to these documents is: http://www.thebsa.org.uk/public-engagement/commissioners/

BAA Commission Guide for Commissioners and Health Boards 

Posted 29th April 2015

Guidance on Identifying Non-Routine Cases of Hearing Loss in Adults


Routine, direct referral adult care pathways in the UK specifically fund hearing aid fitting, but provide no financial support for supplementary or additional forms of rehabilitation, such as communication skills training, additional rehabilitation time or assistive listening devices. Many hearing impaired adults may choose, or would benefit from, additional or alternative intervention, and some are likely to require a significant amount of time and resources for additional assessment and/or rehabilitation. For the purposes of this document these cases are deemed to be non-routine (or complex) cases for hearing loss management. 

This document is intended to enable clinicians to direct hearing impaired adults along the most appropriate treatment pathway and to enable effective discussions between commissioners and Audiology professionals by identifying cases of hearing loss in adults that are likely to be unsuitable for the routine adult care pathway. 

Presentation of these issues may arise at any point in the care pathway, whether at receipt of referral by Audiology, initial assessment, hearing aid fitting (if appropriate) or follow up. 

It should be noted that this document does not advise clinicians on the management of non-routine cases, and clinicians are referred to current evidence-based practice and to the British Society of Audiology’s Practice Guidance documents, particularly the “Practice Guidance on Common principles of rehabilitation for adults with hearing- and/or balance-related problems in routine audiology services.

Download the guidance here


Commisioners will find the Direct Referral Guidelines for Adults here 

These are helpful in developing appropriate standards.

For Paediatric services we suggest looking at the commissioning documents developed in conjunction with the National Deaf Children's Society. Their website is: www.ndcs.org.uk

We will be building additional information here for commissioners and would initially like to direct you to the scope of practice document that will help with understanding the career grades within audiology. This can be accessed here.

For further assistant please contact BAA admin


What is the prevalence and impact of hearing loss? 

More than 10 million people in the UK have some form of hearing loss, and the risk of hearing loss increases with age. This figure is expected to increase to 14.5 million people by 2031.21 

Hearing loss can lead to communication difficulties, social isolation, and emotional distress and can significantly adversely affect a person’s quality of life.22 This appears to affect not only the person with hearing loss, but also those around them such as their partner, family and/or carer.23 

Hearing loss also increases the risk of mental health problems, including depression.24 It is strongly associated with an increased rate of cognitive decline and an increased risk of dementia.25 There is evidence to suggest that people with mild hearing loss are almost twice as likely to develop dementia. The risk for people with moderate hearing loss is three times higher, and for people with severe hearing loss it is almost five times higher.26 

Prevention and early diagnosis of hearing loss can significantly reduce the impacts of hearing loss, including social isolation and mental ill health.27 

Hearing loss can also reduce a person’s ability to manage other health conditions independently. About half of older people in the UK with hearing loss have additional disabilities or long-term health conditions.28 

In addition to increasing use of health and social care services, hearing loss can increase unemployment and sick leave rates, and limit opportunities for career progression. The International Longevity Centre UK estimated that, in 2013, due to lower employment rates for those with hearing loss than across the rest of the population, the UK economy lost £24.8 billion in potential economic

Reference Monitor Report 2015 NHS adult Hearing Services in England: exploring how choice is working for patients. Full report available at: https://www.gov.uk/government/publications/nhs-adult-hearing-services-in-england-exploring-how-choice-is-working-for-patients


21 Action on Hearing Loss. (2011) ‘Hearing matters‘. Available from: www.actiononhearingloss.org.uk/supporting-you/policy-research-and-influencing/research/hearing-matters.aspx 

22 See, for example, Ciorba A et al (2012) ‘The impact of hearing loss on the quality of life of elderly adults‘, Journal of Clinical Interventions in Aging, 7: 159-63; Dalton DS, Cruickshanks KJ, Klein BEK, et al. (2003) ‘The impact of hearing loss on quality of life in older adults’, The Gerontologist, 43(5): 661-68; Mulrow CD, Aguilar C, Endicott JE, et al. (1990) ‘Quality-of-life changes and hearing impairment’, Annals of Internal Medicine, 113(3): 188–94. 

23 See, for example, Wallhagen MI, Strawbridge WJ, Shema SJ, et al. (2004) ‘Impact of Self-Assessed Hearing Loss on a Spouse: A Longitudinal Analysis of Couples’, The Journal of Gerontology, Series B, Psychological Sciences and Social Sciences, 59B(3):S190–6. 

24 See, for example, Saito H et al. (2010), ‘Hearing handicap predicts the development of depressive symptoms after three years in older community-dwelling Japanese’, Journal of the American Geriatrics Society, 58(1): 93-97. 

25 See, for example, Lin FR, Metter EJ, O’Brien RJ, et al. (2011) ‘Hearing loss and incident dementia’, Archives of Neurology, 68(2): 214-20; Lin FR, Yaffe K, Xia J, et al. (2013) ‘Hearing loss and cognitive decline in older adults’, JAMA Internal Medicine, 173(4): 293-99. 

26 Lin FR, Metter EJ, O’Brien RJ, et al. (2011) ‘Hearing loss and incident dementia’, Archives of Neurology, 68(2): 214-20. 

Use of Hearing Aids

For a systematic Review of the evidence for use of hearing aids see the following article by Perez E and Edmonds BA (2012)  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0031831

IQIPS Accredited Audiology Services

Independent assessment and accreditation is a key part of the Royal College of Physicians’ (RCP) IQIPS Programme which seeks to improve the quality of physiological diagnostic services nationally.  The programme has been sponsored by Professor Sue Hill, Chief Scientific Officer at the Department of Health.  It covers the range of physiological diagnostic specialisms which includes audiology, cardiac physiology, gastrointestinal physiology, neurophysiology, ophthalmic and vision science, respiratory and sleep physiology, urodynamics and vascular science.  UKAS has been contracted to deliver the national assessment and accreditation service for all eight physiological diagnostic specialisms and is working closely with the RCP on a plan for the staged roll out of accreditation to each specialism.

The United Kingdom Accreditation Service has granted accreditation to organisations against the requirements of the IQIPS Standard for Audiology Services. This is available by following this link:



 Commissioning Challenges:
Tips, Strategies & Actions
Rachel McCarthy, Consultant Clinical Scientist