Agenda item

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) has been invited to present a report on Audiology Services in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) was invited to present a report on Audiology Services in Oxfordshire.

Matthew Tait (Chief Delivery Officer BOB ICB), and Phil Gomersall (Adult Audiology Team Leader Oxford University Hospitals NHS Foundation Trust) (OUH), also attended to answer questions from the Committee in relation to the Audiology Services in Oxfordshire report.

The Associate Director, Performance & Delivery for Planned Care discussed service commissioning in Oxfordshire and Buckinghamshire, which aimed to improve accessibility through the "any qualified provider" model with 26 community locations. He noted that there had been minimal complaints and positive patient feedback. Phil Gomersall described the adult audiology team, differentiating between community services for age-related hearing loss and hospital services for complex needs, including Ear Nose and Throat (ENT) diagnostics, specialist testing, balance assessments, and rehabilitation for non-age-related conditions.

Members inquired about the broader engagement process related to the commissioning of audiology contracts, beyond the market engagement mentioned in the document. The Associate Director and the Adult Audiology Team Leader explained that this process involved collaboration with communications leads to promote public involvement, although no members of the public attended the sessions. The team also reviewed historical complaints and feedback to address issues within the new service model.

The objective was to enhance accessibility and reduce waiting times. While detailed national comparisons were not provided, the service was designed to meet national minimum standards and effectively address local needs.

Members inquired about how the long waiting lists for more complex audiology services compared to the situation before the contract and the current scenario. Officers clarified that the waiting lists for these specialised audiology services had deteriorated since the pre-contract period. This was primarily due to the impact of COVID-19, which increased waiting times because of the close contact nature of audiology assessments. Additionally, there were national challenges concerning ear, nose, and throat services. Efforts are underway to enhance community providers to help ease some of the burden on secondary care. 

Members inquired about the decision-making process for prioritising areas and determining which patients received services at the community diagnostic centres. Officers clarified that this process was directed by a national programme from NHS England. This programme outlined key diagnostic tests that centres had to offer to achieve accreditation. Initially, the centres focused on tests such as MRIs, X-rays, and ultrasounds, and later expanded to include audiology. The process involved submitting bids for additional funding to support these services. Access to the centres was managed through hospital pathways and self-referrals. 

Members asked about efforts to improve access to the service, raise awareness, KPIs for providers and contractors, and exclusions from the service. The Associate Director and Adult Audiology Team Leader explained that efforts to improve access and awareness included addressing complaints about ear wax removal and informing patients about the service.

Providers were encouraged to market the service effectively, and communications were sent to primary care colleagues to inform them about the service. The KPIs for providers and contractors included a 16-day target for completing assessments and a 20-day target for fitting hearing aids after assessment. Exclusions from the service were based on professional body guidance and included conditions like troublesome tinnitus, which required specialist treatment in a hospital setting.

Members raised concerns about the lack of demographic forecasting data for hearing assessments. They sought to understand plans for future demand, noting that one in six individuals might need such services. The inquiry questioned how this projected demand was being incorporated into planning strategies.

Officers acknowledged that while the current service was flexible to meet demand, there was no specific data on the proportion of self-referrals or the exact future demand. It was noted that the service had stabilised and was meeting current needs, but future planning would involve a population health needs assessment.

The response also highlighted that the increase in demand might not continue at the same rate due to factors like improved hearing protection in workplaces. The planning strategies would be revisited during the recommissioning process, considering the projected demand and demographic trends.

Members inquired about the current appropriateness of the balance between the usage and supply of the audiology service, and whether this balance was expected to remain suitable in the future. Officers responded that the current balance between usage and supply is appropriate, with the service effectively meeting the population's needs. They noted that the transition from the old model had been successful, characterised by high levels of access and low complaint rates.

However, it was acknowledged that ongoing monitoring and adjustments would be necessary based on emerging trends and population needs. Future planning would involve reassessing the service during the recommissioning process to ensure it continues to meet demand effectively.

Members asked about the proportion of self-referrals to the community audiology service and how many received equipment versus wax removal. They also inquired if the 16 working days assessment time applied to self-referrals. Officers stated that specific data on self-referrals was not available but would be provided later. It was confirmed that the 16 working days assessment time applies to all referrals, including self-referrals. Providers must meet this timeframe, and any delays will be reviewed in contract meetings. 

Members requested information on whether remote appointments for cochlear implants and bone-anchored hearing aids required patients to attend remotely or if the provider would come to a nearby location. It was clarified that these remote appointments involved patients attending from their home. Patients used a smartphone connected to the device, and the clinician joined the appointment via video on either the smartphone or a separate computer. This arrangement enabled patients to receive care without needing to visit the hospital.

Members inquired about the practice of providing finance options for hearing aids and the issue of upselling or uplifting, where patients might be sold unnecessary products. A Healthwatch report was also referenced, which mentioned a patient who had been offered private hearing aids instead of NHS devices.

Officers expressed their concern regarding the practice of offering financing options for hearing aids and the possibility of upselling or uplifting, noting that this matter had not previously been reported to the ICB. It was stated that further investigation into these practices would be conducted. Additionally, it was emphasised that NHS hearing aids should adhere to a national minimum standard and should not be considered inferior products.

Members inquired about the determination of complex audiology needs for patients and whether children's cases were adequately identified and addressed. Officers clarified that these needs are determined through established guidance and criteria set by professional bodies, which are clearly defined and understood by both community and hospital providers. It was noted that any ambiguous areas are sometimes resolved through direct communication between providers.

Regarding children's cases, it was stated that paediatric audiology services are managed by the hospital due to the specialised training and equipment required. Officers indicated that there are no current plans to alter this model, although ongoing inspections and reviews may result in future adjustments.

Members requested information about the proportion of patients who were followed up after receiving audiology services and the outcomes indicated by the follow-up data. Officers responded that all patients who received audiology services were followed up, with follow-ups taking place shortly after the initial fitting and then annually for up to three years.

Members inquired about the national evidence indicating a gap between those who need audiology treatment and those who receive it, and whether communications about the service were effectively reaching the public to address this gap. Officers acknowledged the national evidence indicating a gap between those who needed audiology treatment and those who received it. It was mentioned that communications about the service had improved, with efforts made to market the service and inform primary care colleagues.

However, it was also noted that more could be done to increase public awareness and address the gap effectively. Officers indicated that while there had been some success in reaching the public, improvement was still needed to ensure that everyone who needed the service was aware of it and could access it.

Members inquired about the issues with the audiology patient management system, particularly its separation from the OUH electronic patient record system, and what actions were being undertaken to resolve these problems. Officers acknowledged that the separation was identified as an issue. It was mentioned that, despite a unified referral system, patient information continues to be managed locally by each provider.

Members inquired about the national initiative for audiology services and how the ICB managed the workload and responsibilities at the local level. The Associate Director explained that the national initiative for audiology services was integral to the ICB's core commissioning responsibilities. The ICB addressed the workload and responsibilities locally by sustaining the current service model and planning for future demand. They continuously monitored the performance of the services and collaborated with providers to ensure sustainability. Additionally, the ICB engaged with regional and national NHS England colleagues to tackle wider challenges and sought further support when necessary.

Members inquired about the workforce issues in audiology, specifically regarding recruitment and retention challenges and how these were being addressed. They also asked about the risks acknowledged at the beginning of the contract.

Officers explained that the workforce issues in audiology, particularly in recruitment and retention, presented significant challenges. Community providers managed these effectively by partnering with national universities for training and placements, ensuring a steady flow of new audiologists. However, the secondary care sector faced difficulties due to competition with the private sector, which offered more attractive salaries and benefits. The training environment had also evolved, with fewer programmes and a shift to an apprenticeship model, resulting in a delay in qualified professionals entering the field.

The ICB acknowledged that these challenges were not fully anticipated at the beginning of the contract, and the increased community provision had an unintended impact on the hospital sector's sustainability. Efforts to address these issues included engaging with regional and national NHS England colleagues to seek additional support and exploring the option of in-sourcing staff from outside Oxfordshire.

The discussion ended with an emphasis on reducing waiting lists, improving communication with patients about audiology services, integrating patient management systems, and addressing workforce challenges.

The Committee AGREED to the following actions:

• Phil Gomersall would supply specific data on self-referrals in relation to patients receiving hearing equipment versus ear wax removal.

 The Committee AGREED to issue the following recommendations:

1.    For further information to be provided around the level of need for audiology services (including amongst children), and on supply at the local and acute levels.

2.     To support further resourcing to tackle waiting lists and prioritisation, particularly around Community Diagnostic Centres.

3.     For improvements to be made around communications with the wider public to increase awareness of available support from audiology services.

That Community Audiology is brought onto the same Electronic Patient Record system as the rest of Oxford University Hospitals NHSFT.