Lead by Blackburn with Darwen CCG in partnership with
NHS East Lancashire, NHS Blackpool, NHS Chorley & South Ribble, NHS Fylde & Wyre, NHS Greater Preston, NHS Morecambe Bay, & NHS West Lancashire CCGs and Midlands and Lancashire Commissioning Support Unit.
Engagement on NHS Hearing Aid Services
CCGs (Clinical Commissioning Groups) across Lancashire and South Cumbria are working together to re-procure (buy) hearing aid services for age-related hearing loss for those aged 50 years and over. NHS Blackburn with Darwen CCG is leading this procurement on behalf of the CCGs.
An ageing population with an increased likelihood of hearing loss in this poulation, means that demand for both hearing assessment and treatment services is likely to rise substantially. This will result in rising costs and the need for more efficient and effective services to be provided. The Clinical Commissioning Groups (CCGs) as commissioners of the service are committed to the provision of high quality, dedicated and professional hearing services for patients with hearing conditions, centred on clinical assessment and treatment via the most appropriate management pathway. A significant proportion of this client group will have straightforward hearing loss that does not require referral for an Ear, Nose and Throat (ENT) out-patient appointment prior to assessment. These patients would benefit from quick access to adult hearing care services with a referral being made directly from their General Practitioner (GP). This will enable timely diagnosis and treatment.
Currently the CCGs commission hearing aid services for those over 55 years of age suffering from age-related hearing loss, from 10 different providers across Lancashire. These were procured utilising an Any Qualified Provider (AQP) process for a three year period, current contracts are due to expire in April 2019 and have recently been extended to enable the CCGs to re-procure a new contract.
The vision for people with age-related hearing problems is for them to receive, high quality, efficient services delivered closer to home, with short waiting times that are highly responsive to their needs. The service will be free at the point of access.
The aim of the audiology procurement is to procure (buy) a comprehensive patient-centred integrated adult hearing service. This will include the provision of hearing aids for age-related hearing loss in line with national guidance and local requirements for the registered population of the NHS commissioning organisation aged 50 years and over.
Procurements are a routine, tried and tested method of using the market to purchase services that are modern, value for money and which meet the needs of the commissioners (the CCGs). Procurements offer potential providers with the opportunity to be innovative and creative about what they can offer, and in turn, how this can offer value for money and improve patient care.
A Lancashire & South Cumbria Audiology Leadership Group was established in October 2017 to provide guidance, develop a service model, review costs and activities, review the national service specification, review local and national best practice and tariff information. This group also provides oversight and management of the procurement across Lancashire and has representation from all Lancashire CCG’s, patient representatives, clinical experts and subject matters experts in areas such as contracts, finance, procurement and business intelligence.
Proposed service model
The new Adult Hearing Service is for adults (over the age of 50) experiencing difficulties with their hearing and communication who feel they might benefit from hearing assessment and care, including the option of trying hearing aids to reduce these difficulties.
The aim of the service is to provide a comprehensive patient-centred Integrated Hearing Service which will include the provision of hearing aids for age-related hearing loss (non- complex) in line with national guidance and local requirements for the registered population of the NHS commissioning organisation aged 50 years and over.
The vision for people with age-related hearing problems is for them to receive, high quality, efficient services delivered closer to home, with short waiting times and high responsiveness to the needs of local communities, free at the point of access.
Key principles within which the Integrated Hearing Service operates:
- Contribute to improving public health and occupational health focus on hearing loss
- Contribute to reducing the prevalence of avoidable permanent hearing loss
- Encourage early identification, diagnosis and management of hearing loss through improved patient and professional education
- Provide person-centred care, responding to information and the patient’s psychosocial needs
- Support communication needs by providing timely signposting to appropriate services e.g. Assistive technologies.
- Promote inclusion and participation of people who are hard of hearing and to make reasonable adjustments for patients who have learning and development disorders, dementia and mental health conditions.
- Compliance with clinical guidance and good practice
- Ensure services are available to all who are eligible without regard to gender, sexuality, religion, ethnicity, social or cultural determinants. However, where it is deemed clinically appropriate, alternative services may be established that meet the specific needs of one or more groups within a community. Such services will enhance rather than detract from the existing provision.
- Offer appropriate, co-produced information for service users, carers and referrers about the services provided, how they are accessed and about their care.
- Ensure compliance with locally agreed pathways to other services such as Ear Nose & Throat (ENT) as part of collaborative working as one healthcare system.
- To reduce duplication of services (one individual or set of hearing aids per patient, per provider), re-provision of lost hearing aids and multiple referrals to different providers
The expected benefits of the service are:
- Improved access through locally based services as close to the patients’ home or work as possible
- Increased patient choice and control as to where and when their treatment is delivered – providing on-going care closer to home
- Personalised care for all patients accessing the service that is characterised by the co-production of an Individual Management Plan
- Co-ordinated care through an integrated service
- Access to hearing assessment, fitting and follow-up within agreed timeframes, with patients being referred back to the patient hearing centre for on-going support and monitoring
- Provision of active support for patients to make adjustments to their condition and get used to hearing aids
- Care that is evidence-based and provided according to local and national guidance
- Avoidance of unnecessary appointments or services
- Increased compliance and proportion of patients continuing to wear hearing aids
- Increased reported levels of patients at the first review reporting improved hearing and health and wellbeing outcomes
- Increased reported levels of satisfaction from GPs referring into the service
- Reduced social isolation and consequent mental ill health
- Increase in the quality of life for patients, their families/carers and communication partners
Why does it need to change?
CCGs received concerns from clinicians, providers and patients relating to the current provision/service model and pathways for accessing hearing loss services. In response, the CCGs agreed to undertake a service review exercise in 2017 to help inform future commissioning intentions across Lancashire and South Cumbria.
Approach to Engagement
The engagement is now completed. We used a mixed methodology for the engagement. The CCGs co-opted patient representatives as members of the Audiology Leadership Group which is overseeing the procurement. At a provider open day we held, we also ran a patient focus group, as patient representatives had been invited to this. The focus group suggested that an online survey would be appropriate for service users, so following this feedback we created an online survey for hearing aid service users. The CCG’s also attended the Pensioners Parliament in Blackpool and discussed the procurement with delegates.
Action on Hearing Loss gave the CCG’s advice during the engagement period and helped to promote the survey.
Other key stakeholders include:
- Current and potential Provider Organisations
- County Councillors
- PPG networks and groups
- Health Watch (Blackburn, Blackpool, Lancashire)
- Action on Hearing Loss
- Soundz Off
- Deaf Council UK
- Age Concern
- Hearing Link
- National Association for Deafened People (NADP)
- British Deaf Association
- East Lancashire Deaf Society
- Lancashire Deafway
- Lancashire Deaf Link
- Older peoples forums
- Social media
Following a period of engagement and review, further work is being undertaken. The procurement has been extended to allow for further work to be undertaken and we expect the new service January 2020.
How you can get involved
The engagement initially commenced in June 2017, with a second phase of engagement in July 2018. The engagement for the procurement is now complete, however we have kept the on line survey live as it was felt important to keep a track of patient and public views throughout the procurement and for when the hearing aid service is mobilised following the procurement.
The link for people to tell us their views is here: https://www.surveymonkey.co.uk/r/NHS_hearing_aids
Results / Findings
The reports of our findings are here:
Audiology Patient/Stakeholder survey feedback:
Patient workshops were held across Pennine Lancashire
- 23 June in Blackburn and 26 June in East Lancashire
- Stakeholder workshop was held on the 28 June 2017
Summary of feedback and opportunities as follows:
System and processes
- Health and social care system approach and future model to include Prevention, Early Intervention, Education & Training, Audiology assessment and hearing aid fitting, with patients able to access the right service at the right time e.g. wax removal, volunteers, ECLO.
- System to support a patient centred approach to meet individual needs and maximise use of community assets, reduction in variation.
- Pathway to be seamless at all points of transfer with clear criteria for access.
- Develop a deaf awareness strategy with rollout to the general public to support inclusion and reduce stigma.
- Responsive and accessible service providing initial and follow up appointments to meet individual needs including emergency/urgent provision and ease of access to batteries.
- Consideration of a system to support the valuing of hearing aids by patients – deposit or small charge included for replacements.
- Equity of service provision including domiciliary care and care homes through SPOA.
- System to support access to standardised information in a variety of formats.
Support systematic training at appropriate levels for patient empowerment and clinicians to support appropriate referrals and promotion and provision of most appropriate equipment including assistive technology.
- Enhanced communication skill training for all (public, public servants and carers) to support communication with those who are hard of hearing and training to be undertaken by someone who is deaf or hard of hearing e.g. lip reading, interpreters.
- Workforce to support a customer service approach.
- Development of a sustainable multi-disciplinary workforce able to support a range of LTCs at an appointment to reduce appointments.
Information and access to technology to enhance the quality of life.
- Public buildings and GP practices to have standard equipment such as hearing loops.
- Availability of patient information in order to make an informed choice about the range of hearing aids and choices available.
- Single IT systems and sharing of patient information across agencies/services to reduce having to repeat information.
Important aspects for patients are:
People with hearing loss want to be part of society, attend meetings and not be isolated or feel different.
- Patients want the opportunity to provide service feedback via a variety of mediums – making this as easy as possible e.g. Facebook, website survey, survey monkey etc. Feedback to be acted upon.
- Patients want to be empowered.
- One stop shop approach with multiple services based together to reduce appointment based approach.
Improvement in speech and hearing-Q’air, GHABP/COSI.
- To be able to communicate.
- Tools: Patient benefit questionnaire, Aided speech thresholds.
- Use gold standard clinical measures: PTA with bc inc. 3, +6kHz
- Tympanometry if required
- Real ear measurements
- Aided/unaided thresholds
- Patient outcome measure for benefit
- Test bcx measurements
How patient and public involvement has made a difference?
As a result of this work, the following has occurred:
- Commissioners undertook a detailed analysis of the key issues and feedback from patients & carers/stakeholders/providers from the meetings, one to one interview surveys, focus groups and discussions and this has been summarised below:
- The service specification for NHS Hearing Aids has been revised to reflect patient views and experiences as above. See a summary of the comments made and how this has been considered in the service specification available on the CCG website.
- Two patients have told their story to East Lancashire CCG Governing Body and this has led to them being involved in improving the patient handbook in the audiology service at East Lancashire Hospitals NHS Trust.
- A film has been produced, featuring the patient representative on the Audiology Leadership Group, Mr Stephen Finn. This is for other organisations to use and is available on YouTube via the link below. This film describes the challenge of hearing loss and how using hearing loss and hearing aid services can benefit patients. https://youtu.be/KpcZxvHplqI
A review of the previous procurement has been undertaken and we will begin the new procurement in Spring 2019 with the new service expected to be in place by January 2020.