Children’s hearing aid services to be nationally commissioned
Posted September 12, 2012on:
As part of the new Health and Social Care Act 2012 the commissioning (or purchasing) of NHS services will be the responsibility of local Clinical Commissioning Groups (CCGs) except where the service is prescribed in legislation. Prescribed services will be commissioned by the NHS Commissioning Board (NHSCB). Yesterday the DH published the recommendations of the Clinical Advisory Group for the services that should be nationally commissioned from April 2013. (The document is dated June 2012 but it was only publically available yesterday!)
The recommended services that are included and of interest to the audiology and ENT profession, as well as parents of deaf children are:
- Specialist Ear, Nose and Throat Services for Children and Young People including surgical management of rare conditions, surgical management of more common conditions when the child or the procedure is high risk (including the need for PICU or Specialist Anaesthetic management), provision of specified procedures and Specialist Audiology Services. Specialised audiology services consist of those audiological services which are part of a paediatric hearing aid service. In some cases specialised audiology services may not be co-located with specialised ENT surgery services. (p21 & 130)
- Cochlear Implantation Services (p26 & 200)
- Bone Anchored Hearing Aid Services (p26 & 201)
- Auditory Brainstem Implantation Service (p26 & 203)
- Middle Ear Implantable Hearing Aid Services (p26 & 205)
- Other Specialised Ear Surgery (the plastic surgery element is included within the proposed regulation on Specialist Plastic Surgery for Children and Young People.) (p26 & 207)
- Specialist Mental Health Services for Deaf Adults & Deaf Children & Adolescents (p17 & 103)
Also of interest to us because of the populations involved:
- Specialist Services to support patients with complex physical disabilities which including Specialist Augmentative and Alternative Communication Aids (p11 & 44)
- Cleft Lip and Palate Services (p15 & 77 & 152 & 158)
- Specialist Genetic Services (p20 & 95)
- Specialist Plastic Surgery Services for Children and Young People which includes congenital malformations of the ear including: absence of ear, absence/atresia/stricture of auditory canal, macrotia, microtia, misshapen ear, misplaced ear. And congenital malformation syndromes predominately affecting facial appearance incl Goldenhar syndrome, Robin syndrome and Treacher-Collins syndrome. (p23 & 158)
There are also some exisitng services that are already regionally or nationally commissioned that are recommended for transfer to new regulations:
- Alström services (p28)
- Complex neurofibromatosis type 1 services (p29)
- Mental health services for Deaf children and adolescents will include services provided by Highly Specialist Deaf Child and Adolescent Mental Health centres including outreach when delivered as part of a provider network. (p29)
- Craniofacial services (p29 & 152)
- Neurofibromatosis type 2 services (p31)
- Primary ciliary dyskinesia management services (p32 & 166)
- Rare mitochondrial disorders services (p32)
- Stickler syndrome diagnostic services (p34)
What do you think?
National commissioning has the potential to be a very positive move for those low volume, highly complex, high cost interventions such as cochlear implants, and this could mean much greater equity of access across the country to these types of procedures. The big surprise to me is the paediatric hearing aid services included in the recommendations as it neither fits the low incidence or high cost descriptions used to identify national specialist services. More so than many of the other services this recommendation has the potential to have a very major impact on how current services are provided in terms of location, staff, and integration with the rest of the paediatric audiology service. Specialist services are likely to have more experienced staff who see larger numbers of children and build up more expertise. But how is this organised? It isn’t fair to expect families with young deaf children to travel great distances on a regular basis to attend specialist services so how will care closer to home be managed? With a split between local and specialist centres? With a network arrangement where staff travel to see children in outreach centres and/or work with local teams? Or another way?
What are your views? What would you like to see happen?
Update 14th September 2012: Some of your views can be found here.
Update 18th September 2012: The NDCS response to this news can now be read here.