Download Evidence Pack Hearing Aids

Adherence to Evidence Based
Medicine Programme
Evidence Summary Pack (Version 2)
Hearing Aids
Local commissioners working with local people for a healthier future
Sustainable Service Transformation
About the AEBM Programme
Enfield Clinical Commissioning Group, along with our North Central London colleagues, wants to the secure
the greatest health impact it can with its resources by adhering as closely as possible to the clinical evidence
base available.
There is considerable national and international evidence that many procedures offered routinely by the NHS
are of limited clinical benefit to patients in some or all circumstances. Therefore there needs to be careful
consideration as to whether or not a procedure is going to be of any benefit to an individual patient before
deciding to undertake it. To do this we must use the best and most up to date clinical advice and evidence to
ensure we have the best chance of delivering a benefit to each individual patient who is put forward for
treatment. This evidence published by the National Institute for Health & Care Excellence(NICE) as well as
available evidence published by the Royal Colleges and other Clinical Commissioning Groups. This will also
ensure the best value from the services we commission.
To ensure this decision making process is applied consistently, Enfield Clinical Commissioning Group along
with the other Clinical Commissioning Groups in North Central London, adopted a common policy concerning
these procedures that have limited clinical effectiveness in 2012 based on the best available evidence at that
time.
As the clinical evidence base moves on we are now undertaking a further review to ensure that we are using
the best and latest clinical evidence in our decision making. We are also looking at the range of procedures
where the evidence base now suggests we need to make changes to the guidance for individual patient
situations to avoid the risk of undertaking procedures that have little or no benefit to patients or even where the
undertaking of the procedure could result in a risk of harm.
Clinical Leaders at the Clinical Commissioning Group with the full support of the Governing Body are leading
this review. Enfield Clinical Commissioning Group will engage widely and consult formally on the proposals
which emerge, while continuing to work closely with partner Clinical Commissioning Groups in North Central
London.
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About the Evidence Pack
This evidence pack summarises the evidence that the Clinicians working on the AEBM Programme have
reviewed prior to the commencement of the consultation process. Due to the nature of many of the documents
reviewed it is not possible to repeat the evidence in its entirety.
The first version of these Evidence Packs only contained highlights of the information and clinical evidence
reviewed and based on feedback from our public this was seen as an oversight and therefore a more
comprehensive summary is now being provided. These packs will be made available along with the
underpinning documents that were used.
The purpose of the Consultation is to enable clinicians, patients, our public and other stakeholders to contribute
to the debate including identifying additional evidence that may have been missed by the clinicians working on
the programme during the pre-consultation phase.
The views of all participants in the consultation along with any additional evidence that comes to light during the
consultation programme will be taken through further clinical review at the end of the consultation programme.
We would like to thank all who have contributed during the extensive pre-consultation phase (that lasted from
September 16 through to March 17) and all who are now taking the time to contribute during the formal
consultation phase.
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About the Approach Taken
In preparing these Evidence Packs we undertook an extensive review of available clinical data and evidence
and looked in detail at the evidence used (or at least reviewed) by other Clinical Commissioning Groups during
similar exercises. The span of this work included (but was not limited to) the following:
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NICE
BMA
Royal Colleges
All London CCGs
CCGs outside of London including Cambridge, Berkshire, North Staffordshire and many others
Guidance documents available from relevant stakeholder websites
We then collated the evidence including eligibility criteria that CCGs had reviewed (although it is noted not all
may have gone on to implement the changes) and then added in local data such as activity and spend, trend
analysis and benchmarking.
This collated data and evidence was then reviewed by a wide range of clinicians including secondary care
representatives before being summarised into these Evidence Packs for use during the consultation.
The purpose of these Evidence Packs is to provide a summary of the extensive clinical review that was
undertaken prior to the commencement of the Consultation Period but we recognise that further evidence might
come to light during the consultation process and this is the reason for undertaking the consultation before any
decisions are made to ensure we have used all of the available evidence in our final decision making
processes.
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Enfield CCG Evidence Summary
NICE Guidance: Currently under development (Due May 2018)
Information taken from Monitor’s Report: NHS adult hearing services in England: exploring how choice is working for patients
What is the prevalence and impact of hearing loss?
More than 10 million people in the UK have some form of hearing loss, and the risk of hearing loss increases with age. This figure is expected to
increase to 14.5 million people by 2031.
Hearing loss can lead to communication difficulties, social isolation, and emotional distress and can significantly adversely affect a person’s quality
of life. This appears to affect not only the person with hearing loss, but also those around them such as their partner, family and/or carer.
Hearing loss also increases the risk of mental health problems, including depression. It is strongly associated with an increased rate of cognitive
decline and an increased risk of dementia. There is evidence to suggest that people with mild hearing loss are almost twice as likely to develop
dementia. The risk for people with moderate hearing loss is three times higher, and for people with severe hearing loss it is almost five times
higher.
Prevention and early diagnosis of hearing loss can significantly reduce the impacts of hearing loss, including social isolation and mental ill health.
Hearing loss can also reduce a person’s ability to manage other health conditions independently. About half of older people in the UK with hearing
loss have additional disabilities or long-term health conditions.
In addition to increasing use of health and social care services, hearing loss can increase unemployment and sick leave rates, and limit
opportunities for career progression. The International Longevity Centre UK estimated that, in 2013, due to lower employment rates for those with
hearing loss than across the rest of the population, the UK economy lost £24.8 billion in potential economic output.
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Enfield CCG Criteria Summary
NCL CCG ORGANISATION
Enfield CCG
CRITERIA
AVAILALE
N
Barnet CCG
N
Haringey CCG
N
Islington CCG
N
Camden CCG
N
NCL CCG ORGANISATION
North Staffordshire CCG
CRITERIA
AVAILABLE
Y
Stole on Trent CCG
Y
South Norfolk CCG
Y
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NOTES
All North Central London CCGs utilise the National AQP Standard
which is aligned to guidance from NHS England that existed at the
time of issuing contracts. They also utilise the NHS England
Funded Bone Anchored Hearing Aid Scheme.
NOTES
It should be noted that whilst a criteria or evidence exists on the
Website of a CCG we may or may not have had the opportunity to
confirm whether the policy, proposed threshold or evidence has
been enacted or remains in place once enacted. We are simply
identifying other CCGs who have undertaken a similar exercise to
add their evidence to our own. This caused some confusion with
the first version of these Evidence Packs.
Spend & Activity Data including
Trend Analysis and Benchmarking
Local commissioners working with local people for a healthier future
Sustainable Service Transformation
Enfield CCG Activity & Spend Data
Activity 2015/16
608
Cost 2015/16
£233,841
Note: QIPP Opportunity is estimated to be in the region of £10-50k.
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For Further Information contact
[email protected]
or call
0203 688 2814
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