Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Telecommunications relay service wikipedia , lookup
Lip reading wikipedia , lookup
Hearing loss wikipedia , lookup
Hearing aid wikipedia , lookup
Noise-induced hearing loss wikipedia , lookup
Sensorineural hearing loss wikipedia , lookup
Audiology and hearing health professionals in developed and developing countries wikipedia , lookup
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: 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 2 The objectives of the Hearing Therapy service are: 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 3 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 4 5.1.1 Audiology Under the current service model, the Provider is required to provide the following: 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: 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 5 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 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: 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 6 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: Any type of hearing loss, including complex and profound. Auditory Processing Disorder. Tinnitus & Hyperacusis Adjustment to new hearing aids 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 7 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. 8 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. 9