Last year, North Staffordshire clinical commissioning group (CCG) decided to stop providing NHS hearing aids to people with symptoms of hearing loss, and instead set restrictions based on the level of hearing loss that people have. The CCG estimated that this restriction will reduce its spending by 0.07% per year (about £200,000). It’s a decision that has proven unpopular with both local councillors and patient groups, who argue the CCG has not considered the impact delaying hearing care will have on patients or the budget. South Norfolk CCG is considering following suit, targeting over 50s in particular, while others, such as North East Essex, have withdrawn similar plans after reviewing the evidence.
But is North Staffordshire CCG right? It claimed that 40% of hearing aids issued on the NHS were never used – but even if the figure is correct (and critics say it is out of date), is it reasonable, at a time of intense pressure on services, to cut hearing services to save money?
Dr Andrew Dunlop, a GP and trustee of the charity Hearing Link, says not. The fact that audiology services are currently under pressure ”would not be tolerated as an excuse anywhere else in the NHS”, he argues, adding: “Hearing care is seen as an easy target.”
He notes that the North Staffordshire CCG’s decision flies in the face of a commitment of NHS England, the body that oversees all CCGs, to improve quality in hearing care and make hearing loss a priority. If people in North Staffordshire are not using hearing aids, Dunlop argues, the CCG should address the quality failings in the NHS, not penalise patients.
There are other reasons to believe that the decision is short-sighted and will, in the long term, cost the NHS more. Age-related hearing loss affects nearly half of people aged over 50, rising to 71% of people over the age of 70. Currently about four million people in the UK could benefit from a hearing aid but don’t have one. Harjit Sandhu, head of policy at the National Community Hearing Association, points out that people who suffer hearing loss are more likely to become socially isolated, depressed and to leave the workforce early, creating pressure on health and social care budgets.
It’s a view lent official support in a report by NHS regulator Monitor on adult hearing services. The report argued that hearing loss can “increase unemployment and sick leave rates”, as well as “increasing use of health and social care services”. It found that “improved access [to hearing aids] could also lead to savings for commissioners and the wider system by reducing pressures on health and social services”.
So what is the alternative to cuts to NHS hearing care?
Monitor found that the NHS can do more for less by using the any qualified provider (AQP) model to commission hearing services. Its report found that AQP had improved standards and transparency and resulted in prices 20% to 25% lower than what the NHS paid before. AQP also offered CCGs the opportunity to improve follow-up support, reducing the number of hearing aids being left in drawers.
AQP, currently employed by half of CCGs, gives patients a choice: they can choose to access hearing care in a hospital, or on the high street from providers such as Specsavers, Boots and a growing number of social enterprises. David Furness, senior policy adviser at Monitor, argues: “Widening access to services is one thing that can be done to encourage people to get the help they need.”
Some CCGs find that improving access can increase uptake of hearing care. But this is inevitable, says Sandhu: “The NHS has been warned about the scale of unmet hearing need since the 1980s, so making services more accessible, by offering care closer to home, will result in more people coming forward for help. That is a good thing”.
Community-based hearing care – on the high street, for example – is easier to access. There is no need to visit the hospital to get a new hearing aid battery or a hearing aid repair. Using AQP, Sandhu says, the cost per patient goes down significantly (a view backed up by the Monitor report) but because more patients are seen, the total cost can go up. In effect, the NHS does more for less. Hearing care should be seen as an investment in the future, with savings down the line, as people with hearing loss stay active and well for longer.
The Monitor report found high rates of satisfaction among patients with the quality of the services provided by AQPs. Colin Campbell, director of professional services for Specsavers hearing centres, is not surprised: “You simply cannot offer this service unless you are a qualified provider, and the bar is set extremely high. AQP’s principle is to be a tariff-based system, and that means that all the providers compete on quality – they cannot compete on price.” Providers such as Specsavers now offer extra services such as same day testing and fitting, home visits and walk-in aftercare clinics.
GPs already using the AQP model have seen benefits. Dr Neil Paul, a GP based in South Cheshire, says his surgery has hosted an outsourced audiology service for five years. The local CCG uses AQP, and as a result there is now a choice of 20 local providers. “I’m all in favour,” he says. They seem to operate to a clear pathway. It’s close to patients’ home, quick and high quality.” It also frees up hospital audiologists to focus on more complex cases, he says.
If we want to increase patient choice while improving healthcare and saving the NHS money in the long-term, then more widespread use of AQP seems like the best answer. “Patients should have a range of options, both in the GP surgery, on the high street and in the hospital,” says Furness. “A broad availability of hearing services means that we are more likely to overcome the unwillingness of some patients to seek help if they have problems with their hearing.”
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