KidsAudiologist

Has NHS audiology improved for deaf children?

Posted on: February 13, 2012

I tend to shy away from polictical commentary but there are massive changes afoot as part of the coalition government’s NHS Reforms  and there is a statement that we keep hearing claiming that the previous Labour government had 13 years (1997-2010) to improve the NHS and failed to do so, and I’m taking issue with this. I can only talk for children’s audiology in England but for those who weren’t working in, or using their NHS audiology service during this time you might be interested in some of the hugely significant changes that took place during that time…

Modernising Children’s Hearing Aid Services (MCHAS)

Between 2000 and 2005 the government invested in Modernising Children’s Hearing Aid Services. MCHAS was a research and training programme which introduced digital signal processing hearing aid technology into the NHS. During this period all audiology departments in England received funding for new equipment and training so that now all children are routinely fitted with digital hearing aids. Alongside the introduction of new hearing aid technology, new fitting procedures and working practices were introduced. Guidelines covering these procedures were written and are now accepted by the profession as standard quality practice.

Newborn Hearing Screening   

The roll-out of newborn hearing screening in England was announced in December 2000 and from March 2006 all babies in the UK were offered a hearing screen within a few days of birth. During this time the average age of diagnosis of a baby born deaf fell from 2.5-3.5 years of age to just a few weeks of age, massively improving the opportunitites for early intervention and establishing effective communication early.

Early Support

Early Support was a Government funded programme from 2002-2006 involving the Department for Education and Skills, Sure Start and the Department of Health. The purpose of the programme was to improve the delivery of services to disabled children under three and their families across England. Recognising that the needs of families and children are very diverse, as is the range of professionals from health, education and social services who are involved, the interests of deaf children and their families, as newborn hearing screening was gradually introduced across the UK were at the heart of the programme. Some resources now available from the Early Support programme include a service audit tool, a range of disability-specific information booklets for families (including deafness), the Common Monitoring Protocol – a developmental journal for recording the details of a deaf child’s milestones, and materials for families and professionals on making informed choices.

Waiting times

The last government made a pledge to reduce the amount of time patients waited for treatment to less than 18 weeks by December 2008. The “18 Weeks target” covered pathways that involved or might involve medical or surgical consultant-led care and so initially hearing aid services weren’t included and suffered as finances locally were diverted to meet the target together with increased demand for services led by MHAS (the adult equivalent of MCHAS above). The Health Select Committee (2007) heard that the average waiting time for first hearing aid fitting was 41 weeks rising to 2 years in some places. The committee was persuaded of the need to include hearing aid fittings in the waiting time targets and made recommendations to the government.  The government responded that they had “no plans to revisit the scope of the 18 Weeks target but have been clear with the NHS that no local health system will be credible in claiming success on 18 Weeks if it does not make excellent progress in tackling long waiting times affecting large numbers of its local population, including those waits that are technically outside the target”, but followed up with the Department of Health-led Audiology Improvment Programme including a series of “Transforming…” documents on different aspects of the audiology service and patient pathways. To everyone’s credit in audiology services everywhere, as well as those working for the Department of Health teams, the 18 weeks target was met by the majority of areas by the December 2008 timeframe with some continued work with ‘challenged sites’ during 2008-9. NHSP Quality Standards made it clear that hearing aids should be fitted within 4 weeks of diagnosis for babies following their newborn hearing screen, but NDCS continued to express that 18 weeks was too long for those older children with acquired deafness, who were referred into the system later, to have to wait. The government agreed and the Transforming Services for Children with Hearing Difficulties and their Families in 2008 stated that they shouldn’t have to wait longer than 4 weeks as well.

Quality Standards

Professional societies and organisations have published protocols for the most common audiological procedures for more than 20 years but these were mostly for adult test procedures. It has only been since MCHAS and the introduction of newborn hearing screening that audiologists have had the benefit of protocols for babies and children. NDCS has long campaigned for better audiology services for children and their families and has published Quality Standards for paediatric audiology services since 1994. However, it was only during the last government that a serious interest was taken in producing national standards. Led by advisers at Department of Health level but owned by the professionals we have since seen the introduction of peer-review quality assurance in the newborn hearing screening programme as well as widely used quality rating tools for paediatric audiology services.

Summary

Do I think everything in the garden of children’s audiology is rosy? No. Not yet, we still have a way to go. Services can still be patchy with examples of excellence and dreadfulness! Do I think it’s fair to say that the NHS hasn’t improved during the period of the previous government? No. In the 20+ years I’ve worked in audiology there have been HUGE changes that mean deaf children are seen quicker, diagnosed sooner, have better technology offered and fitted using improved protocols and procedures, a better qualified workforce and where family is seen as a centrally important feature in that deaf child’s outcomes. Am I worried about the NHS Reforms and what this means to children’s audiology going forward? Yes. I am worried that the structural changes risk breaking up integrated services and that services for children with rare conditions (such as deafness) will be poorly recognised or understood by new commissioning bodies leading to poor decisions on commissioning services. The current government must take care to build on the progress made and aspire to create audiology services that can deliver quality to all families, in all areas, all of the time.

Although I’ve concentrated on the policy in England there have been parallel changes in Wales & Scotland too. For links to standards and programmes in the other countries as well as a guide to what parents can expect from their audiology service go to the NDCS website (log-in required – it’s free and takes a couple of minutes).

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1 Response to "Has NHS audiology improved for deaf children?"

Another very interesting blog

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