President – British Society of Hearing Aid Audiologists The Health Reforms - Their Impact on Services for People with Hearing Loss and Deafness Barry Downes President – British Society of Hearing Aid Audiologists London 17th January 2013

President – British Society of Hearing Aid Audiologists An Independent Hearing Care Sector Perspective A Focus on Patient Choice Barry Downes President – British Society of Hearing Aid Audiologists London 17th January 2013

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness What is BSHAA? Professional body established for nearly 55 years. Represents the large majority (80%) of independent sector audiology professionals. Hearing Aid Audiologists/Dispensers are regulated by the Health & Care Professions Council (HCPC). Membership ranges from sole practitioners to employees of large national companies. BSHAA core beliefs are in personalised, patient-centred care which is both evidence-based and outcomes-focused.

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness Why should an organisation representing an independent sector profession, have opinions about health reforms and how they may impact on NHS services for hearing impaired adults? Many BSHAA members are on their journey towards qualification for provision of NHS adult hearing services. BSHAA wholly supports the fundamental objective of the AQP programme which enables hearing impaired adults to have a wider choice of providers of NHS hearing services.

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness A significant widening of the choice of local providers means NHS adult hearing services are no longer solely hospital-based. Access to hearing care should become easier and more convenient with early stage patient input into decisions about by whom and how their hearing needs are going to be met. So, to this extent, the impact of reforms relating to services for hearing impaired adults should be an entirely positive one.

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness BSHAA welcomes any measures which remove barriers and disincentives to seeking and, hopefully, accepting help for hearing loss. Providing patients with a wider choice of providers should be good for the hearing health of the public but we have concerns that the intentions behind extending patient choice may be too slowly and variably implemented. We regret that commissioning of NHS adult hearing services is subject to local variations rather than a national commissioning framework.

Do barriers and disincentives remain which:- The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness NHS and independent sector audiology professionals, contend daily with the reluctance of hearing impaired adults to accept the help and advice they need. Do the health reforms affecting NHS adult hearing services go far enough? Do barriers and disincentives remain which:- Limit or even prevent the exercise of patient choice? Encourage further postponement of the beginning of the rehabilitation journey supported by the services of competent audiology professionals?

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness BSHAA regrets that the opportunity has not yet been taken to remove GPs as the gatekeeper for access to NHS adult hearing services. Hearing impaired adults should be able access NHS hearing care with the same freedom of choice as they access vision and dental care. We remain concerned that GPs will continue to be a barrier for many hearing impaired adults and will not enable freedom of informed patient choice under the AQP programme.

Some reasons for this concern:- The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness Some reasons for this concern:- Evidence published by Action on Hearing Loss indicates that 45% of patients complaining of hearing-related problems do not obtain a referral from their GP. We have little confidence that GPs are increasing their understanding of the effects of unaided hearing loss, especially when age-related, and what amplification technology can achieve. We believe there is widespread ignorance amongst GPs about the entitlement of hearing impaired adults to exercise choice of local, qualified providers.

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness Other disappointments about the health reforms and extension of patient choice

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness With patient choice being so fundamental to the health reforms, we would have thought that achieving this objective would involve a process which was not biased towards larger organisations. The pathway towards becoming a qualified provider is costly and complex and the reality is that almost all sole practitioners and smaller independent sector companies do not have the resources to cope with the AQP process and, effectively, have been excluded.

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness Services for the rehabilitation of hearing impaired adults through provision of hearing aids can only be considered successful and cost-efficient if they achieve a key outcome……. ………hearing aids are being used regularly, beneficially and patients report a satisfying improvement in their quality of life. Although an outcome with a number of components, it’s easily measured but at a stage in the rehabilitation journey which is individually variable for the outcome to be validly assessed.

The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness Patient-centred, adult hearing services involve a combination of time and technology with both being applied with as much personalisation as possible to achieve the desired outcomes. A major concern is that the tariff for adult hearing services under the AQP programme:- Seriously limits the provision of post-fitting aftercare. Offers little incentive to deliver a service which meets the needs of hearing impaired adults as individuals. Will encourage a more process-based, de-personalised approach to service provision and that patient satisfaction and benefit outcomes will suffer.

A Focus on Patient Choice The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness A Focus on Patient Choice Conclusions

BSHAA is wholly supportive of extending patient choice. The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness BSHAA is wholly supportive of extending patient choice. We are concerned about:- A lack of awareness by GPs of the existence of the AQP programme and a patient’s right to choose their provider. GPs attitudes towards hearing loss which can too often make them a barrier to NHS hearing services and may not facilitate the exercise of informed patient choice. Local commissioning arrangements are creating variations in service provision rather than the consistency of a national commissioning framework. The exclusion of smaller independent sector providers from the AQP programme. NHS adult hearing services becoming too process-based, lacking in important patient-centred elements of care.

Thank you for listening! The Health Reforms -Their Impact on Services for People with Hearing Loss and Deafness Thank you for listening!