Published: 18/12/2003 Volume II3, No. 5886 Page 30 31

Capacity in NHS audiology has been boosted and access to its services increased thanks to an unusual public-private partnership.Phil Kennedy explains Public-private partner-ships are often regarded with suspicion, so how did a project seeking to improve capacity in audiology services win the backing of the Department of Health and private providers?

Since 2000, the DoH has been working with RNID - formerly the Royal National Institute for Deaf People, the UK's largest voluntary organisation representing the needs of deaf and hard-of-hearing people - on modernising the NHS hearing aid services programme.

Over 9 million people in the UK have a hearing loss of some degree. Before this modernisation programme, research by RNID revealed that in some services, spending on each adult hearing aid was a pitiful£20.

Other reports identified such a high level of dissatisfaction with outdated analogue hearing aids - the only available NHS option at the time - that a significant minority of patients rarely wore their device.

RNID lobbied the government for investment in audiology services.As a result, RNID was invited to manage the modernisation programme for England on behalf of the DoH. To date, the government has invested£125m to ensure that every NHS audiology department in England is fitting digital hearing aids by March 2005.

Since 2000, over 130 NHS sites have joined the programme and benefited from significant investment in the IT necessary for the fitting of digital hearing aids.

Over 175,000 NHS digital hearing aids have been fitted to approximately 125,000 people.

But long waiting lists for audiology services have been common, due in part to a national staff shortage. This has been compounded by additional time spent with each patient (follow-up appointments are now standard) and greater patient demand for digital aids.With waiting times as long as 24 months, it was clear that capacity had to be addressed. But predictive models of shortfall in audiology staffing levels show an increasing skills gap and no end in sight.

So the hearing aid services programme explored opportunities to draw on existing private sector capacity. Last year, a pilot was set up between several hearing aid companies and two NHS audiology departments - one covering Royal Shrewsbury Hospitals trust and Princess Royal Hospital trust, and another for Leeds Teaching Hospitals trust.

Registered hearing aid dispensers' staff were trained in the programme's protocols, and 350 NHS patients agreed to be seen by high-street dispensers rather than hospital clinics. Digital aids were supplied by the NHS, and service remained free at the point of delivery.

This pilot was evaluated by the Medical Research Council's Institute of Hearing Research in Nottingham.

Professor Adrian Davis, who carried out the evaluation, said: 'Private sector audiology can make available additional affordable capacity, so it makes practical sense to draw on their expertise and experience.'

Following the success of the pilot, a national framework agreement was developed. Private companies were invited to tender, and two were appointed - David Ormerod Hearing Centres and Ultravox.Modernised hearing aid services can now access this additional capacity without needing to enter complex tender and contract negotiations, and the framework agreement will promote consistent standards of service across the NHS and the private sector.

The over-riding message from the pilot sites was that true partnership between the NHS and private companies is essential if the scheme is to work. There is a lack of shared culture between NHS audiologists and colleagues in the private sector, and the key to success was strong local ownership which enabled the two sets of professionals to meet regularly and share common ground. As both groups worked together, they were able to voice their opinions and began to dispel misconceptions about 'the other side'.

Head of service in Shropshire George Kirk, based at Royal Shrewsbury Hospitals trust, summed up the project's success: 'The project certainly tackled some long-held stereotypes and produced an atmosphere of trust and respect.'He also observed the growth of a 'no blame' culture, as 'we all began to develop the ability to say 'Oops'without feeling insecure.'

NHS audiology has made great strides in the past three years, but there is still much to be done - particularly if the recent advances are to be sustained beyond 2005 when central ring-fenced funding for the programme ceases and becomes part of the primary care trust baseline allocations.

PPP is one way in which the NHS can expand capacity, as well as increasing ease of access for deaf and hard-of-hearing people. It is an excellent example of how traditional differences can be embraced, which is timely as some professional bodies in audiology work look towards unification. l Big deal: how the partnership works For implementation of the national framework, trusts must choose to opt into the scheme, for which there is some central funding.The modernising NHS hearing aid services programme has a project plan and patient materials based on the experiences of the pilot study.This provides trusts with a picture of the managerial commitment required so they can make an informed decision.

Patients seen via the public-private partnership route must have access to the same support services as anyone seen by the NHS, so a clear induction for the registered hearing-aid dispensers on the local NHS service is crucial both in laying the foundations for a partnership and maintaining consistency of service.

The standard of service provided by the private dispensers is dealt with by a quality assurance framework.This requires the companies to train their staff in NHS protocols and establish regular monitoring meetings between the dispensers and the NHS head of service, who retains clinical accountability for the patients.

Patients must consent to receiving their NHS care from a registered dispenser.There is initial administration for selecting the patients to be offered this option, and for the transfer of their records between the NHS and dispensers.They cannot self-refer.

Further information

www. rnid. org. uk

www. mhas. info

Key points

Improvements in hearing aid provision has been hampered by long waiting lists and a shortage of staff.

Pilots last year showed the potential to increase capacity by using private sector capacity.

A partnership between the NHS, the voluntary sector and two companies provides digital hearing aids free.

Phil Kennedy is manager of the modernising NHS hearing aid services programme.