Download The Community Adult Audiology and Hearing Therapy services

Bath and North East Somerset
Community Health and Care
Services:
Community Based Adult
Audiology and Hearing Therapy
Services
SD13
1.
Introduction
NHS Bath and North East Somerset CCG currently commissions Adult Audiology
and Hearing Therapy services from both community and secondary care providers.
2.
Purpose
The purpose of the service is to provide a safe hearing service for adults registered
with a Bath and North East Somerset GP practice, including those individuals who
are physically housebound or with no fixed abode;
To provide an accessible, effective rehabilitative hearing therapy service for adults
with long term conditions affecting hearing and balance, with the aim of enabling
patients to improve their understanding of, and to manage their condition
The service is aimed at adults (over the age of 18) who are experiencing difficulties
with their hearing and communication and who feel they may benefit from hearing
assessment and care. This will include the option of trying hearing aids to reduce
these difficulties.
The service is expected to provide equitable access to high and consistent quality
care for all people and should recognise published clinical guidelines and good
practice (as set out in section 3).
2.1
Aims and Objectives
The aim of the service is to provide a comprehensive, person-centred community
adult hearing service for hearing loss, which operates in line with national guidance
and local requirements.
People with hearing problems should receive high quality services that are delivered
closer to home, with short waiting times and free at the point of access. The service
should be responsive to the needs of the local community.
The Community Adult Audiology service should:
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Improve public health and occupational health focus on hearing loss
Reduce 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, and respond to information and psychosocial
needs
Support communication needs by providing timely signposting to lip reading
classes and assistive technologies and other rehabilitation services
Promote inclusion and participation of people who are deaf or hard of hearing
Comply with clinical guidance and good practice
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The objectives of the Hearing Therapy service are:
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3.
To enable people to self-manage the symptoms of hearing loss and associated
conditions.
To address and reduce the emotional distress associated with conditions of hearing
and balance.
Improved use of relaxation techniques to manage anxiety related to condition and
where levels of anxiety and depression require treatment by other services, to refer
on.
To support people to adopt best practice approaches to maximise the possibility of
increased habituation to tinnitus and hyperacusis, and their self management of the
condition.
To use patient education, information and guided support to enable patients to
manage their conditions and self assess their progress.
To provide a service that guides people to determine the progress they want to make
and to help them make their objectives achievable.
To provide advice to people with balance problems where it is safe to do so.
To manage a person’s perception of how their condition impacts on their quality of life
into realistic targets.
To provide education programmes for public sector and care agency staff, to improve
awareness and skills in supporting people with hearing loss in different environments
and services.
To resolve disputes and communication breakdown in the workplace and within family
units, where possible.
To provide continuity of care for patients treated within the ENT and Audiology
Services at the RUH and St Martin’s Hospital.
National/local context and Evidence base
Hearing assessment, fitting, follow-up and aftercare services should follow best
practice standards and recommendations as defined below:
 NHS Core principles
 National Institute for Health and Clinical Excellence Guidance/Quality
Standards, when available
 Department of Health: Standards for Better Health
 Clinical protocols, guidelines and recommended procedures as specified by
British Society of Audiology and British Academy of Audiology
 Guidelines on the acoustics of sound field audiometry in clinical audiological
applications.
 Hearing Aid Handbook, Part 512
 British Academy of Audiology Guidelines for Referral to Audiology of Adults
with Hearing Difficulty (2009)
 Guidance on Professional Practice for Hearing Aid Audiologists (British
Society of Hearing Aid Audiologists, 2011)
 Hearing Matters Report – Action on Hearing Loss 2011
http://www.actiononhearingloss.org.uk/supporting-you/policy-research-andinfluencing/research/hearing-matters.aspx
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 Recommended standards for pre-hearing aid counselling (Best Practice
Standards for Adult Audiology, RNID, 2002)
 Recommended standards for deaf awareness (Best Practice Standards for
Adult Audiology, RNID, 2002)
 ‘Transforming Adult Hearing Services for Patients with Hearing Difficulty – A
Good Practice Guide’, DH, June 2007
The Community Adult Audiology Service should be provided in accordance with
guidelines issued by the British Academy of Audiology Guidelines for Referral to
Audiology of Adults with Hearing Difficulty (2009) and the British Society of Hearing
Aid Audiologists Protocol and Criteria for Referral for Medical or other Specialist
Opinion (2011).
4.
The policy context
The impact of hearing loss in adults can be great and can lead to social isolation,
depression, loss of independence and employment challenges.
Assessing the hearing needs of patients with hearing loss, developing an individual
management plan and providing appropriate interventions can reduce isolation,
facilitate continued integration with society and promote independent living.
One in six people in the UK have some form of hearing loss. Most are older people
who are gradually losing their hearing as part of the ageing process, with more than
70% of over 70 year-olds and 40% of over 50 year-olds having some form of hearing
loss (http://www.actiononhearingloss.org.uk/)
Around 2 million people currently have a hearing aid, however, approx. 30% of these
do not use them regularly, and there are a further 4 million people who do not have
hearing aids and would benefit from them.
In addition, with an ageing population, there will be an estimated 14.5 million people
with hearing loss by 2031. The World Health Organisation predicts that by 2030,
adult onset hearing loss will be a long term condition ranking in the top ten disease
burdens in the UK, alongside diabetes and cataracts.
The ageing population means that demand for both hearing assessment and
treatment services is set to rise substantially over the coming years. However, a
significant proportion of this client group will have routine problems that do not
require referral for an Ear, Nose and Throat (ENT) out-patient appointment prior to
assessment. These patients would benefit from direct access to adult hearing care
services with a referral being made directly from their GP, enabling timely diagnosis
and treatment.
5.
Service Delivery
5.1
Current Service Model
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5.1.1 Audiology
Under the current service model, the Provider is required to provide the following:
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Clinic based assessment, fitting and follow-up of referred patients.
Domiciliary assessment, fitting and follow-up if the patient’s physical or
cognitive limitations prevent them from attending a clinic based
appointment. This is currently based on prior approval process within the
PCT for each domiciliary request
Test and clinic rooms that comply with section 4.2 of the British Society of
Audiology Recommended procedure, March 2004.
Equipment and software for audiometric assessment and the fitting and
evaluation of hearing aid suitable for both clinic based and domiciliary
assessment, treatment and follow up, including a minimum of:
o Otoscope;
o Ear impression taking equipment;
o Ear mould modification equipment;
o Audiometer and Real Ear Measurement systems that store data
electronically in a form that can be readily exported and read
into the local NHS database;
o Calibration equipment that is maintained against national and
international standards (BS EN ISO 389 series);
o A Patient Management System that stores and exchanges data
(including PROMs, e.g. Glasgow Hearing Aid Benefit Profile
(GHABP), COSI or equivalent) electronically and securely in a
form that is compatible with the local NHS audiology Patient
Management System compliant with the Data Protection Act
1998 and NHS guidance on Information Governance.
o Appropriate hearing aid fitting software;
o Computer/s that adequately support the above systems;
o Equipment and electrical connections shall meet the NHS
standards for safety of equipment used with patients
The Provider is also required to:
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deliver the service (and Patient pathway) in line with the Quality Enhancement
Tool (http://audiology.globalratingscale.com/), and in accordance with current
clinical protocols specified by British Society of Audiology
http://www.thebsa.org.uk/
work toward accreditation of their service via the Quality Enhancement Tool
in line with the standards to be published in 2011
follow the procedure set out by the British Society of Audiology, 2010,
available from http://www.thebsa.org.uk/ for pure tone air and bone
conduction threshold audiometry with or without masking and determination of
uncomfortable loudness levels
fit Digital hearing aids available through the NHS Supply Chain contract (as
negotiated by PASA) and respond to the patient’s requirements for skin toned
or coloured hearing aids. Hearing aids may be purchased through NHS
Supply Chain or directly from manufacturers
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explain to the Patient using written information in advance of the assessment
date:
o the purpose of the test (i.e. the test determines the presence and
degree of hearing loss and may require subsequent fitting of a
hearing aid)
o patient preparation (e.g. having ears checked for wax and having
wax cleared if necessary)
o who will perform the test and where it will take place
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deliver assessment and rehabilitation services for hearing impaired people
who are referred by their GP:
o for an initial assessment and diagnosis of their hearing problem and
to determine whether they might benefit from hearing aids;
o as existing users of hearing aids.
Assessment
Each patient has a clinical assessment to include:
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a clinical interview to establish relevant symptoms, co morbidities, auditory
ecology and significant social issues (including expectations and
motivation);
Pure-tone air and bone conduction thresholds;
Loudness discomfort levels (where required);
Assessment of current activity restrictions and participatory limitations
using PROMs, e.g. Glasgow Hearing Aid Benefit Profile (GHABP), COSI
or equivalent;
Integration of assessment and expectation to enable patients to decide on
amplification options (hearing aids or Assistive Listening Devices (ALDs))
appropriate for their setting
Fitting
Fitting of hearing aids where this is appropriate and the patient wishes to accept
provision of aids. This should include onward referral to any relevant support service
in accordance with agreed local protocols. The Provider is required to offer a face-toface or telephone follow-up appointment between 6 and 12 weeks following hearing
aid fitting.
Follow up
If required, a minimum of one follow up session is available per patient, by phone or
face-to-face if the patient chooses to access it. Additional follow ups are made
according to patient need or an onward referral for patients requiring additional or
ongoing support with their hearing aid(s) to other services including Hearing Therapy
and the Volunteer Service.
Ongoing care and maintenance
Post follow up patients remain under the care of the service for a period of 3 years
and should be able to self- refer for advice and repairs at any time. Post follow up
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patients may request referral on to Hearing Therapy or Volunteer Services for
support
Every two years the service should contact the patient with a reminder of the
services available, i.e. reassessment, repairs or referral for additional support with
their hearing aid(s).
Repairs
The Provider is responsible for the maintenance of all hearing aids prescribed and
fitted by them. Repairs and maintenance should in all cases be available within two
working days of receipt of request. A postal repair service should also be available.
Onward referral
The decision for onward referral to a medical or surgical specialist for further
investigation is the GPs.
5.1.2 Hearing Therapy
The service receives referrals from ENT consultants, audiologists and GPs, of
conditions that cannot be treated by them and/or conditions that have had some form
of treatment but which require additional support. For example patients may report
being stressed by their symptoms of hearing loss, or who have tinnitus, who are
struggling to wear their hearing aid or who have speech recognition problems with
normal hearing levels.
Referable conditions are:
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Any type of hearing loss, including complex and profound.
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Auditory Processing Disorder.
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Tinnitus & Hyperacusis
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Adjustment to new hearing aids
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Hearing aid maintenance
The service provides assessment, individual goals and then rehabilitation, which
includes information, coping strategies, the ability to self assess their progress and to
recognise when to use different communication tactics. The overall purpose is to
enable them to better manage their condition.
Discharge is agreed with the person once their progress has been reviewed and a
satisfactory outcome has been achieved. People can self-refer back to the service if
they need to. They are actively encouraged to make telephone contact with their
therapist should they have any queries.
5.2
Service Development - Opportunities and Issues to be
addressed
5.2.1 Increased demand for services
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An ageing population and an increase in the incidence of long term conditions will
have an impact on the demand for adult audiology services. Currently, providers are
already experiencing problems with managing the level of referrals from GPs.
Consequently, waiting times are longer than the CCG would like.
There is an opportunity to increase the number of local service providers as there
are several independent sector community adult audiology providers already
operating in Bath and North East Somerset that are accredited as NHS providers.
These organisations already provide services for other CCGs across the country.
In addition to providing additional service capacity, these providers tend to operate
on the High Street and would offer greater convenience for service users. They also
tend to have better access in that they offer weekend and evening appointments and
have walk-in services, so patients do not have to arrange and wait for follow up
appointments.
The commissioner wishes to explore all options for a single commission Hearing
Impairment/Hearing Loss service that includes Hearing Therapy and Audiology that
encompasses both secondary care and community services, and in addition includes
the assessment and case management of adults with hearing loss and the provision
of community equipment, information and advice.
The aim would be to have a number of providers including the High Street working
together to deliver the spectrum of services and offering greater choice and access
for service users.
5.2.2 Common tariff structure across providers
At present, the two service providers operate under different tariff structures. The
Community Based Adult Audiology service is commissioned as a three –year
package of care. Similar services provided by the RUH are commissioned as part of
the wider RUH contract and a tariff is paid for individual items of service.
Having different tariff structures creates problems for patients when they wish to
move from one provider to the other during a three year period of care. There is an
opportunity to review the current tariff structures and to develop a common tariff
structure across providers.
5.2.3 Requirement for GP re-referral
At present, GPs are asked to re-refer patients when they have completed a three
year period of care. This is considered good practice as patients should be reviewed
by their GPs on a regular basis and they may require re-assessment. This has an
impact on demand as existing service users are re-referred back in to the service.
There is an opportunity to review the referral pathway and to consider opportunities
to streamline service provision, whilst still operating within nationally recognised
standards.
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6.
Whole system relationships
NHS BaNES CCG actively encourages partnership working and expects the
Provider to form effective partnerships with existing providers where their services
are complementary to the community based audiology service, in particular, the
Audiology Department of the Royal United Hospitals NHS Trust Bath (RUH) and the
Hearing Therapy team.
The Provider is expected to work with other organisations to support patients with
managing their hearing loss and to promote independent living. They should ensure
a seamless integration of the service within the wider health, voluntary, other
community, mental health and secondary care services and social services
environment e.g. lip-reading classes, equipment services etc.
7.
Interdependencies and other services
The Community Adult Audiology and Hearing Therapy services should be seen as
part of wider integrated adult health and social care hearing services, working in
partnership with GPs, Primary Health Care teams, Ear Nose & Throat (ENT)
departments, Audio-Vestibular Medicine (AVM), Audiology Departments, Local
Authority, the voluntary & community sector and independent providers.
The Provider is required to promote and publicise the service across the GP
practices in Bath and North East Somerset and other community based providers.
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