The Hearing Loss and Deafness Alliance

In mid-April, the Hearing Loss and Deafness Alliance strategy group met face-to-face for the first time since pre-Covid days. In the room were representatives of the British Academy of Audiology, the British and Irish Hearing Instrument Manufacturers Association, Royal National Institute for Deaf people, National Deaf Children’s Society, British Deaf Association and the National Community Hearing Association. BAA were represented at the meeting by BAA President, Dr Samantha Lear, and Marketing & Communications Manager, Victoria Adshead.

Each organisation present had to suggest up to three outcomes/priorities they would like the Alliance to work on in the coming months. The Alliance will focus on key outcomes that Alliance members would be willing to commit time and resources to. These outcomes may typically relate to the broader work that Alliance members are doing, where working together will either enhance their activity or mean that the objectives can be more effectively achieved.

BAA Priorities to feed into the Alliance Strategy meeting

BAA identified the key problems to be addressed for the audiology profession, which impact patient care, from board opinion, workshops, member feedback, service issues, etc. BAA suggested the following priorities:

1. Key problem to be addressed: The Audiology Workforce

Workforce shortages affecting both the NHS and private sector. Insufficient number of audiology graduates entering the workforce.  Over half of audiology graduates are no longer working in the NHS after 5 years. Coupled with an ageing workforce and ageing population, demand rapidly outstripping capacity.

(Acknowledgment that there is a need for different types of provision, but the rapid expansion of the large high street private providers has exacerbated workforce shortages, and led to a crisis within the NHS)

Outcomes needed to address the problem (changes in the real world)

There is a pipeline of qualified audiologists sufficient to staff NHS and private sector, with appropriate post qualification training.

The major barriers to achieving those outcomes

• Lack of awareness of audiology as a profession generally
• Resistance to offering placements / clinical opportunities within the NHS who believe they don’t have the capacity
• “Aggressive” recruitment from degree programmes by large high street providers
• Attrition from profession in first few years post qualification
• Inadequate post qualification training

The changes being sought to achieve the outcomes, e.g., legislative change, policy change, good practice guidance, etc.

• More promotion of audiology as a profession by NHS, Unis, schools
• Funded degree programme commensurate with other NHS staff – tie in to working within NHS for at least a year (similar to some other professions) would benefit NHS and private providers in terms of experience
• Collaborative approach between NHS and private providers to support workforce changes needed.
• Training provided on a national basis, rather than by manufacturers etc

There are concerns about education, since the degree programme changed from 4 to 3 years, but the curriculum has been reviewed with all relevant parties. However, the larger high street providers are offering students placements when the NHS is struggling to accommodate these. Then, high street providers can recruit graduates more easily with higher wage remuneration packages early on, but graduates are missing out on non-routine NHS experience, which would inform their routine work in whichever sector they pursue a career in.

The Alliance could work together to ask for action to tackle workforce issues urgently in a cohesive way – including increasing funding for courses, recognition of different training routes, encouraging a collaborative approach between the NHS and the private sector, acknowledging that both could provide a different aspect in developing the workforce. Training routes for all should be clear and cohesive, including non-graduate pathways.  The pre-registration year/Preceptorship would be beneficial IMO for both BSc (Audiologists) and MSc (Clinical Scientist) graduates.

**********

2. Key problem to be addressed: Quality assurance of services

Audiology does not have mandatory service accreditation or other quality assurance scheme. Consequently, there is limited IQIPs accreditation uptake, and quality assurance is highly variable and suboptimal within Audiology across both the NHS and private sector provision.

Trusts and commissioners do not know what to expect from services to hold them to account. Often rely on feedback on patient satisfaction or number of complaints, rather than any objective evidence of service quality.

Not all providers who should be accredited are accredited – e.g. private providers who see children should be accredited by CQC, but no one oversees this. And currently, anyone can remove wax – this should be accredited to protect patients.

Outcomes needed to address the problem (changes in the real world)

All audiology services are externally reviewed against quality standards and accredited as appropriate. This is mandatory, with the same standards for all providers

The major barriers to achieving those outcomes

• No national QA of audiology services
• No leadership to oversee quality
• No additional resource for NHS services to achieve IQIPs accreditation
• Trust management and Commissioners not aware of quality standards and indicators of quality – focus of NHSE on activity data and waiting time targets rather than quality measures

The changes being sought to achieve the outcomes, e.g., legislative change, policy change, good practice guidance etc.

• Leadership/overview of all hearing care service providers
• Mandatory QA programme from NHSE for all providers who provide services to the NHS
• All private providers accredited/registered as appropriate
• Resources for NHS services for quality assurance/improvement, as would be in the private sector

The Alliance could push on this, ensuring that all services meet the same standards no matter who is providing them, that there is mandatory QA against the standards, and that commissioners of services know what to expect and how services are performing. But also the work of quality improvement and accreditation requires resourcing in an NHS department.

**********

3. Key problem to be addressed: lack of mandatory professional registration

Professional registration provides some assurance that a clinician is appropriately qualified/trained, engages professionally with a mandatory body, has a code of practice etc, and can be reported/ investigated if there are concerns. Clinical Scientists and Hearing Aid dispensers must register with HCPC, but for audiologists, registration is not mandatory.

 Outcomes needed to address the problem (changes in the real world)

All staff who see patients for hearing care, including wax removal, should be registered with a registration body, giving service users confidence in professionals and a way to raise concerns.

The major barriers to achieving those outcomes

• Registration is not mandatory
• Unclear roles and responsibilities with AHCS/HCPC/RCCP

The changes being sought to achieve the outcomes e.g., legislative change, policy change, good practice guidance, etc.

• A single recognised accreditation body for audiology
• Mandatory requirement for professionals providing audiology services to be mandated