Agenda item

Michelle Ford, Assistant Director of Commissioning and Rob Howard, Technical and Strategic Planning Manager (audiology), Eastern & Coastal Kent and Bob Deans, Deputy Chief Executive, Bill Millar, Assistant Director of Primary/Community Service Contracting and Lynne Townsend, Locality Commissioning Manager, West Kent Primary Care Trusts will be in attendance for this item to respond to questions about the commissioning of Audiology Services.

(Michelle Ford, Assistant Director of Commissioning and Rob Howard, Technical and Strategic Planning Manager (Audiology), Eastern & Coastal Kent Primary Care Trust, Bob Deans, Deputy Chief Executive, Lynne Townsend, Locality Commissioning Manager, West Kent Primary Care Trust, Mr M Kershaw, Chief Operating Officer, East Kent Hospitals Trust, Mr G Douglass, Chief Executive, Maidstone & Tunbridge Wells NHS Trust, Mr A Horne, Chief Executive and Mrs A Willoughby, Head of Audiology, Medway NHS Trust and Mr J Beadle, Darent Valley Patient and Public Involvement Forum, were in attendance for this item)

(1)       The Committee had before them a briefing note prepared by Dr David Turner, Research Officer to the Health Overview and Scrutiny Committee, which included details about:-

            (a)       modernising NHS audiology services;

            (b)       the growth in waiting times;

            (c)        the Public Private Partnership;

            (d)       the end of ring-fenced funding;

            (f)         national waiting time target;

            (g)       interim diagnostic targets;

            (i)         Phase 2 Independent Sector Treatment Centre procurement;

            (j)         Improving Access to Audiology Services in England;

            (k)        Commons Health Committee report;

            (l)         Department of Health Good Practice Guide;

            (m)      the current situation on waiting times; and

            (n)        the Clinicenta procurement.

(2)       Members of the Committee also had before them written evidence from Eastern & Coastal Kent Primary Care Trust, West Kent Primary Care Trust, East Kent Hospitals Trust, Medway NHS Trust, Darent Valley Patient and Public Involvement Forum and a note from one of the Forum members, John Beadle.

(3)       The Committee’s consideration of this item followed the Committee’s discussion of this issue on 9 March 2007.

(4)       The Primary Care Trusts had responded to questions in writing (which were followed up by the Members at the meeting) about:-

(a)               targets regarding waits for diagnostic tests;

(b)               whether it was intended that routine, non-Ear, Nose and Throat (ENT) audiology referrals would conform to the 18-week referral to treatment (RTT) maximum wait standard by the end of 2008 (although these referrals were not formally covered by the 18-week RTT maximum waiting target);

(c)               how and when the PCTs would meet their stated long-term target of reducing the maximum RTT waiting time to eight weeks;

(d)               what the level of unmet need for audiology services (including analogue-to-digital upgrades) was, how this had been estimated and whether current procurement plans would be sufficient to address this;

(e)               whether providing upgrades to digital hearing aids for patients who already had analogue hearing aids was as important a priority as providing hearing aids for new patients; and

(f)                 the cross-PCT procurement of services from Clinicenta and how this procurement related to the government’s previously announced plan to procure centrally 300,000 independent sector audiology pathways per annum over five years.

(5)       Both East Kent Hospitals Trust and Medway NHS Trust responded to questions relating to how they were implementing the approach recommended by the Department of Health in Transforming adult hearing services for patients with hearing difficulty: a good practice guide (June 2007), encompassing: use of new technology, streamlining systems and processes, new models of care and re-profiling the workforce.  The Committee was also anxious to hear how soon fitting of hearing aids occurred after diagnostic testing. 

(6)       Following the question-and-answer session with representatives from the Primary Care Trusts and acute hospital Trusts, the Committee invited Mr Beadle, the Patient and Public Involvement Forum representative for Darent Valley Hospital, to address the Committee in support of the paper which he had submitted.

(7)       In his paper Mr Beadle had pointed out that the following were the basic causes of current problems in some areas:-

(a)               failure to adhere to best practice standards in audiology, published by the Department of Health in 2002;

(b)               failure to identify the number of patients expected to require digital hearing aids or even set up a data collection system for that purpose;

(c)               failure to adequately fund the Modernising Hearing Aid Services programme, with funding unrelated to catchment area size;

(d)               failure to monitor performance of audiology departments by the Healthcare Commission, either in the star rating programme or in the current Annual Health Check;

(e)               failure to review management of audiology departments and relationships with ENT departments as identified in Audiology in Crisis, published by the Royal National Institute for Deaf people (RNID) in 2001;

(f)                 total indifference to the “postcode lottery” situation by a succession of Health Ministers;

(g)               too great a concentration on the issuing of digital hearing aids for new patients by the RNID and the Department of Health; and

(h)               introduction of a telephone hearing test by the RNID without discussion with NHS audiologists, which had greatly exacerbated existing capacity problems.

(8)       Having heard what health colleagues, and Patient and Public Involvement Forum representatives had had to say in response to all the Committee’s questions, the following conclusions were reached by the Committee.

Conclusions

The Committee concluded that:-

(a)              further work needed to be done to inform the public of the new services being provided by Clinicenta;

(b)              work needed to be undertaken on transport issues in relation to accessibility of healthcare services (the Committee noted that this was a piece of work that it had set aside for a Topic Review Select Committee to undertake early in the New Year);

(c)               the issue of the Joint strategic Needs Assessment should be picked up by the Health Overview and Scrutiny Committee in conjunction with both Health and Adult Social Care colleagues;

(d)              Public Health colleagues should ensure (possibly using Kent TV) that the public were made aware of the risks to their hearing posed by prolonged exposure to loud music;

(e)              data collection and collation for audiology services must be improved, to enable commissioners to commission services effectively;

(f)                 it needed to be recognised that dealing with a patient with audiology needs was about more than just fitting a hearing aid;

(g)              patients were entitled to copies of their audiograms;

(h)               audiology should be recognised as an important service in the strategic plans of the Primary Care Trusts;

(i)                 Hi-Kent Kent provided a valuable and well-respected service;

(j)                 further work should be undertaken by the Primary Care Trusts and others to see whether it might be feasible to provide audiology services through “High Street” practitioners (along the same lines as dental and optical services);

(k)               the Healthcare Commission Annual Health Check should take account of RTT waiting times for audiology services;

(l)                 a written report on audiology services should be received by the Health Overview and Scrutiny Committee every four months;

(m)            audiology patients should be subject to an automatic recall;

(n)               as there had been no audit of audiology needs across the population of Kent, this needed to be undertaken as a matter of urgency;

(o)              patients should be encouraged to return hearing aids where they were no longer required or are not being used;

(p)              PCTs and others needed to consider carefully the mental health needs of people with hearing impairment.

RESOLVED that:-

(a)              the conclusions of the Committee be conveyed to all those identified as having matters to take forward; and

(b)              the Committee would expect an update on how these issues were being dealt with when it received the first written review of audiology services in four months’ time.