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MINUTES OF THE ELEVENTH MEETING OF HEARING AND BALANCE UK
[formerly known as NCPA founded in 1990]
held at the National Hospital for Neurology and Neurosurgery, London
on Thursday 30th January 2013
Present: Mr Adam Beckman Chair
Mr David Couch
Dr Pritti Mehta
Dr Gill Painter
Mr Alan Torbet
Mr Gary Webster
Dr Peter West
Mrs Catherine Ward
BAA
BATOD
AoHL
BAPA
BSHAA
BAEA
BAAP
BSA (taking minutes)
1. WELCOME AND APOLOGIES
Apologies for absence received from Huw Cooper (BSA), Mel Ferguson (NBRUH), Gerry
O’Donoghue (BAO-HNS).
2. MINUTES OF THE LAST MEETING AND ACTIONS
Page 1. Paediatric Audiology: Adrian Dighe will represent BAPA not Medical paediatric Audiology
Medicine.
Page 5. BAAP. The first two sentences of the paragraph will be amended to read ‘Peter thanked the
group for circulating information regarding the Hallpike Prize which was awarded to an ENT specialist
for his study on glue-ear. There were problems in recruitment to the registrar grade.
3. MATTERS ARISING FROM THE MINUTES
There were no matters arising.
4. AQP – the national picture
Adam reported that there was a lot of discussion around AQP at the UKCoD conference which was
held two weeks ago. Alan said that BSHAA has concerns which are recorded in his briefing report to
this meeting (attached). There are concerns around patient information and GP understanding of AQP.
Pritti suggested that HAB UK could possibly attribute a view. The DH plans to have short term and
long term evaluations. Sue Hill has indicated that at present it is not clear who will take leadership of
AQP. It is likely that it will be a team within the Commissioning Board. Clarification is required on
this. It is important to ensure pressure is kept on DH to complete the processes within a reasonable time
scale. Peter commented that within the medical profession medical audits are undertaken and
suggested that perhaps processes of evaluation should be audited and the outcomes looked at. This
audit suggested a need for rigorous independent research. AoHL will probably want to promote the use
of that framework in support of a long term evaluation. There is a likelihood that AQP will affect
children’s services – children’s referrals will go through the GP route.
Adam referred the group to Google ‘Supply to Health AQP map’ and confirmed that providers have to
apply and meet criteria for AQP. IQIPS – need to be working towards accreditation.
The Clinical Advisory Group will meet on Thursday 31st January. 8 organisations have gone forward
for IQIPS accreditation and one of these has been awarded. A report will be published which will
show where ‘the bar’ has been set. Alan Torbet commented that he has received feedback that the cost
of accreditation is substantial.
The group considered that the issue of evaluation of AQP needs to be followed up. It is something that
the BSA may be best placed to carry out on behalf of DH if suitably funded. Adam agreed to write to
DH on behalf of all HAB UK member groups to seek clarity and offer support.
ACTION: Adam Beckman
The meeting considered whether HAB UK should set up a research group for audit purposes, but noted
that this might be better placed within member organisations.
Adam referred the group to the Atlas of Variation which provides useful date.
6. CLINICAL COMMISSIONING – changes to commissioning in England
Peter commented that he had been contacted by a Sussex commissioning group who were asking for
guidelines for referral. He was able to provide four pages of detailed treatment guidelines. The
commissioning group produced a one page flowchart in an effort to avoid unnecessary guidelines.
Peter indicated that this one page flowchart does not cover issues related to balance.
The group understood that some audiology departments had been told not to make contact with
commissioning boards and this would be done through their Trust but other had been advised to speak
to commissioners.
AoHL sent a letter and list of 5 priorities i.e. early diagnosis, access to services by people with hearing
loss, etc. AoHL is planning a long term engagement with CCGs.
The group noted that the commissioning guidelines would provide help to CCGs, and agreed that HAB
UK should contact NICE to ask for an agenda on timescales and what is going out in the meantime.
Adam agreed to draft a letter for consideration by all members of the group.
ACTION: Adam Beckman
7. SPECIALIST COMMISSIONING IN ENGLAND
This will include permanent hearing loss in children. Stakeholder meetings due to be held in February
will discuss paediatric commissioning. Gill Painter will be attending one of these meetings. Adam
informed the meeting that there are around 130 items being taken out of the CCG which will be dealt
with by specialist commissioner. Everything within audiology is under the name of ENT. It is not
possible to change the heading because this has been signed off by Government. It includes implanted
hearing devices, paediatric hearing aid services, vestibular schwanoma, cleft lip and palate. In the short
term this does not mean a great deal of change in the first few months. There will be area teams which
will have tight service specifications. Once service specifications are agreed there will probably be
three years to transform services. There are gaps in adult services but specialties have been done for
implanted devices. There is a risk of hearing services which include balance, tinnitus, adults with
complex auditory needs and adults with learning difficulties being lost in these changes.
Positives for the paediatric side are that there is an opportunity to improve outcomes by having
specialist staff with special skills. The group agreed that the formation of specialist service skills
would be excellent and would improve standards.
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Local Offer – schools and public services have to make provisions. If they are not provided, the local
authority will have to make provision. There will be around 20 area teams which are part of the
National Commissioning Board. Meetings about this will take place on 18th (Nottingham) and 19th
February (London). David Couch indicated that it would be useful if someone from education attended
this meeting. Adam will forward information about the meeting to David and Gary cc Louise Murdin
and Adrian Davis.
ACTION: Adam Beckman
8. PAEDIATRIC AUDIOLOGICAL MEDICINE
Adam will chase up with GMC to talk about paediatric audiological medicine workforce. A meeting
will be set up to include Gill Painter and a representative from BAAP. BAPA has written to the
director of paediatric health (see BAPA report).
ACTION: Adam Beckman
9. BRIEFING REPORTS
BAPA – report attached.
BAAP –
 Peter was pleased to report that there has been one new paediatric consultant appointment in the
North West (filled by two part-time consultants on a job-share basis) and three new consultant
appointments (either made or in the offing) in adult audiovestibular medicine (all based in
London – St Helier (Carshalton), St. George’s and National Hospital for Neurology &
Neurosurgery) plus an advertisement for a new half-time paediatric appointment in Tottenham.
There are still vacant posts for registrars.
 Following intervention by the RCP and Joint Neurosciences Council, it has been confirmed that
the UCL Diploma / MSc in audiovestibular medicine based at the Ear Institute will remain an
integral part of training and assessment within the speciality for at least the next five years.
 Peter will forward information about this year’s Hallpike Prize to member groups for
circulation.
ACTION: Peter
 Dafydd Stephens Essay Prize – a new award open to BSA, BAAP, BAPA and IAPA members
will be launched at this year’s BAAP conference with the first prize to be awarded at the March
2014 conference.
BSHAA – report attached.
BSA –
 In the absence of the BSA representative Catherine reminded the group about forthcoming BSA
meetings: London Evening Meeting (April), PAIG (May) and Annual Conference (September).
She passed on Kevin’s invitation to any of the member groups who would like to be included as
part of the organising committee for the Conference to email Catherine.
 Catherine asked if all member groups are still happy to continue with the reciprocal agreement
to publicise each other’s meetings where no cost is involved. All present agreed.
 Catherine asked if it would be possible for all representatives of the group to email their reports
at least 2 working days prior to HAB UK meetings in order that they can be read ahead of
meetings. Those present agreed to make an effort to do this.
AoHL –
 AQP evaluation framework has been published.
 AoHL recently played a part in supporting the UKCoD conference. Information is available on
the AoHL website.
 AoHL will be publishing a new 5-year strategy from April 2013.
BAEA – report attached.
BATOD – report attached.
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BAA – report attached. Adam reported that BAA administration services are now based in Scotland
and will be reviewed again in 5 years.
MRC IHR – report attached.
9. ANY OTHER BUSINESS
Screening
Agenda in England is being run and then commissioned on a national if rather complicated basis. The
National Commissioning Board will have a screening team within it, and the actual commissioning will
be done by the Area Teams which are “sub-regional”. The lead for screening and immunisation will be
at consultant level. There will be a small team of senior people who will be liaising on a day to day
level with people providing screening services. There will be a newsletter sent out regularly to inform
about the changes. The changes should be good in terms of quality assurance.
APD
Gary Webster informed the meeting that a small working party is being put together to find children
with APD. Gary and David will discuss this further.
ACTION: Gary, David
12. DATE OF NEXT MEETING
Wednesday 5th June 2013, 11.30 a.m. to 3.30 p.m Board Room, Royal National Throat Nose & Ear
Hospital, Grays Inn Road.
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