improving access to audiology_[1]

Improving Access to AudiologyServices in England

Audiology Report 5/3/07 15:47 Page ofci

Audiology Report 5/3/07 15:47 Page ifcii


March 2007

Audiology Report 5/3/07 15:47 Page i

DH INFORMATION READER BOX

Policy EstatesHR/Workforce PerformanceManagement IM & TPlanning FinanceClinical Partnership Working

Document purpose Best Practice Guidance

Gateway reference 7837

Title Improving Access to Audiology Services inEngland

Author Department of Health

Publication date March 2007

Target audience PCT CEs, NHS Trust CEs, SHA CEs,Foundation Trust CEs, Medical Directors,Directors of HR, Directors of Finance, GPs,Communications Leads, Audiologists, ENTand Audiology Consultants, Heads ofAudiology Services

Circulation list

Description The Audiology Framework sets out theaspiration to transform patient experience ofaudiology services, with a series of actionsthat the NHS will take to help make thishappen. It sets out how health reform leverscan be brought to bear to improve quality,efficiency and access to audiology services.

Cross ref N/A

Superseded docs N/A

Action required N/A

Timing N/A

Contact details Becky FarrenPhysiological MeasurementCommissioning Directorate4N14 Quarry HouseLeedsLS2 7UE

For recipient’s use

Audiology Report 5/3/07 15:47 Page ii

Hardness of hearing anddeafness affect the livesof large numbers ofpeople, and can limitactive participation infamily life and society ifnot assessed and treatedappropriately.

That is why the Department of Healthintroduced digital hearing aids in 2001 for NHSpatients, backed by a drive to reduce the costof the equipment, and £125m of extrainvestment. The independent sector began toprovide NHS audiology services through thePublic Private Partnership (PPP) scheme, andthe third sector also became involved. Morerecently the Department has worked with theNHS to collect better information, which isshowing that many people face unacceptablylong waits.

This document sets out a simple aspiration: forlocal health systems to transform theexperience of the audiology service for all theirpatients. This requires a radical reduction inwaiting. The most complex audiology cases(those properly referred to ENT) will becovered by the target of treatment within 18weeks of referral by December 2008. And theremaining routine adult hearing loss casesshould be assessed within 6 weeks by March2008, in line with the diagnostic waiting timemilestone on which local commissioning plansare based. It is also good practice for thesubsequent hearing aid fitting to be carried out

soon after or at the same time as assessment.In short, no local health system will be crediblein claiming success on 18 weeks if it does notmake excellent progress in tackling longwaiting times affecting large numbers of itslocal population, including those waits that aretechnically outside the target.

This framework document sets out how healthreform levers can be brought to bear toimprove quality, efficiency and access toaudiology services. It also describes nationalwork intended to support this.

The framework has been developed with theinvaluable input of members of a nationalaudiology working group. An expert workinggroup will continue to meet to take forwardaspects of this framework and advise onimplementation. It will also be a forum forconsidering other new ideas for serviceimprovement as they emerge.

Local health systems are responsible forcommissioning services to meet the needs oflocal people. This national framework sets outthe tools that they can use to transformaudiology services.

Ivan Lewis MPParliamentary Under Secretary of Statefor Care Services1st March 2007

Improving Access to Audiology Services in England

1

Foreword

Audiology Report 5/3/07 15:47 Page 1

Introduction1. The Department of Health’s overall aim is

to improve a number of key outcomesfor patients, namely:

• Health and wellbeing

• Safety and effectiveness

• Responsiveness

• Efficiency and affordability

• Equality

2. The vision for people with hearing andbalance problems is for them to receive,high quality, efficient services deliveredcloser to home, with low waits and highresponsiveness to the needs of localcommunities, free at the point of access.

3. The goal is for local health systems totransform the experience of theaudiology service for all their patientswith a radical reduction in waiting times,with the most complex cases (properlyreferred to ENT) treated within 18 weeksby December 2008 and with routinereferrals sent direct to audiologydepartments assessed within 6 weeks byMarch 20081. It is also good practice forthe subsequent hearing aid fitting to becarried out soon after or at the same timeas the initial assessment.

4. The main way in which transformationwill be achieved and sustained is throughlocal health systems applying to thedesign and delivery of their audiologyservices the health reform mechanisms ofbetter commissioning and pathwayredesign, choice and competition,information and incentives.

5. Each local audiology service shouldbecome self-improving, making use ofthe incentives and levers that exist tomeet demand and to drive improvedquality and performance to deliver abetter experience for patients. Audiologyservices should be actively encouraged tointroduce new service delivery ideas asthey emerge without waiting for centralintervention. Good commissioning,choice, information, tariffs, the spread ofgood practice and workforce tools can beused locally to transform the experiencefor patients.

6. Focusing on the responsiveness ofservices in particular, the purpose of the18-week maximum wait target is to cutall avoidable waits and unnecessary stepsand to significantly improve the patientexperience. The 18-week target doescover those audiology referrals thatinvolve hospital consultant2-led services,e.g. ENT. These account for an estimated


2


1 In line with the diagnostic stage-of-treatment milestone which covers all diagnostics.2 Medical or surgical


50%3 of all audiology referrals andinclude the more complex cases likely torequire surgery or more complexassessment and intervention such aspaediatric referrals, as well as 20% ofadult hearing loss referrals (usually thoseat the more severe end of the hearingloss spectrum). The target does not coverthe other 50% of all audiology referralsfor routine adult hearing loss that aresent or come directly to audiologydepartments.

7. As the NHS Operating Framework for2007/84 said, there are risks to thedelivery of the 18-week objectivebecause of the potential for referrals thatdo not need to be made to hospitalconsultants5 – such as referrals direct toaudiology departments for routinehearing loss – to be redirected viahospital consultants in order to bringthem into the scope of 18 weeks.Commissioners should therefore assessthe audiological needs of their localpopulations and any capacity gaps, anddevelop and commission the rightamount of appropriate pathways, fromNHS, independent, and third sectorproviders as appropriate, to substantiallyreduce waits across the whole patientpathway.

8. Every single audiology assessment,irrespective of referral route, is alreadysubject to the diagnostic test milestonesof 13 weeks by March 2007 and 6 weeksby March 2008. These are intended toensure that all diagnostic tests are carriedout sufficiently speedily by March 2008to make 18 weeks achievable byDecember 2008. If the GP refers for anaudiology assessment, the 6-week periodbegins at the point of GP referral. Whilstthese milestones are not formally part ofthe 18-week target, no local healthsystem will be credible in claiming successon 18 weeks if it does not make excellentprogress in tackling long waits for allhearing loss cases, which affect largenumbers of every local population, acrossthe whole pathway. PCTs will need toensure local providers deliver themilestones by performance managementand through their local contracts. PCTswill be performance managed against themilestones by SHAs.

The service today9. Hardness of hearing and deafness affects

millions of people, with hearing aids usedby an estimated two million. Treatmentsfor more complex cases include theprovision of bone-anchored hearing aidsand cochlear implants.


3

3 DH and Manchester Research Council modelling4 Para 2.10 http://www.dh.gov.uk/assetRoot/04/14/11/95/04141195.pdf5 Medical or surgical, e.g. ENT surgeons


http://www.dh.gov.uk/assetRoot/04/14/11/95/04141195.pdf

10. Data on adult hearing aid services (AHS)is strongest. The NHS provides at least2,600,000 AHS appointments a year,broken down roughly as follows:

• 600,000 assessments, including newpatients and reassessments

• 500,000 hearing aid fittings in one orboth ears

• 500,000 follow up appointments tocheck that aids are working

• over 1,000,000 ‘repair’ appointments,e.g. to re-tube aids

• AHS services also provide supportand counselling

11. This equates to an estimated 500,000complete AHS pathways per annum forassessment, fitting of a digital aid and

follow up and 100,000 pathways whereno aid is fitted but the patient may havewax management, middle earmanagement or participate in watchfulwaiting.

12. The biggest concern is access, particularlyto AHS. The National data collectionintroduced last year shows that, of the170,000 people awaiting all audiologyassessments at the end of December2006, 113,000 (two thirds) had beenwaiting more than 13 weeks. Theaverage expected wait for an audiologyassessment is 17-18 weeks, which islonger than the expected wait for anyother of the 14 groups of diagnostic testson which monthly data is collected.About 85% of those waiting more than13 weeks for an audiology assessment


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Table: Variation in waits for audiology assessments at end December 2006

Expected Patients Average Wait waiting over Total % over

(weeks) 13 weeks Waiting 13 weeks

North East 32 9,256 13,201 70%North West 13 13,157 21,277 62%Yorkshire and the Humber 15 11,892 15,461 77%East Midlands 22 9,361 13,889 67%West Midlands 20 18,234 28,026 65%East of England 10 4,846 8,620 56%London 20 9,465 13,829 68%South East Coast 45 12,742 16,101 79%South Central 12 5,594 11,110 50%South West 16 18,927 28,518 66%


are on adult hearing loss pathways, andtherefore face a further wait (on whichthe NHS does not yet systematicallycollect data) for hearing aid fitting.

13. Performance varies across the country.As the table shows, the number ofpeople waiting more than 13 weeks foran assessment varies, with expectedaverage waits from 10 weeks in the Eastof England compared with 45 weeks inSouth East Coast.

14. There are also significant variations inmodels of service, activity levels,workforce skill mix, productivity andcosts. These issues have been highlightedby the Department’s 18-weeksphysiological measurement diagnostics6

programme which has focussed onidentifying waits and solutions for anumber of clinical specialties includingaudiology.

Commissioning15. Commissioning is the means by which

the NHS secures the best possibleoutcomes for patients and taxpayers.Stronger PCTs and the acceleration ofpractice-based commissioning (PBC),together with the incentives introducedby the health reforms, provide theopportunity for more effective

commissioning of audiology services.Guidance on commissioning was set outin the Commissioning Framework7 in July2006.

16. Every PCT is responsible forcommissioning the full range of healthservices for its population, includingaudiology, working in partnership withpractice-based commissioners. TheCommissioning Framework set out the‘commissioning cycle’, which applies asmuch to audiology as to any otherservice.

17. The needs of the local population shouldbe assessed, involving a rigorousanalytical approach of populationsegmentation and risk stratification andinput from public health professionals,local authorities, GPs, patients and thelocal community. Nationally, theunderlying demand for audiology serviceshas been increasing and will continue toincrease as the population ages. Routinehearing loss among adults is by far themost common audiological condition.

18. The rate at which demand presents forassessment has been increasing, mostnotably with the introduction since 2001of digital hearing aids, which are adistinct technological step forward over


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6 http://www.18weeks.nhs.uk/public/default.aspx?main=true&load=ArticleViewer&ArticleId=557 7 http://www.dh.gov.uk/ProcurementAndProposals/Tenders/RecentlyAwardedAndExistingTenders/Recently

AwardedExistingTendersArticle/fs/en?CONTENT_ID=4137055&chk=i3NEiK


http://www.18weeks.nhs.uk/public/default.aspx?main=true&load=ArticleViewer&ArticleId=557

http://www.dh.gov.uk/ProcurementAndProposals/Tenders/RecentlyAwardedAndExistingTenders/RecentlyAwardedExistingTendersArticle/fs/en?CONTENT_ID=4137055&chk=i3NEiK

the standard analogue aid they replace.Digital hearing aids can be set to matchmore precisely the need of the individualbut can take extra time to fit and tune.The effect of this and the increase indemand has been to keep waits up.

19. Existing service provision needs to bereviewed. Local health communities willidentify gaps and the potential forimprovements in existing services. PCTswill use the aggregated intelligence oftheir practices and their local needsassessment to identify gaps orinadequacies in provision, as well asbroader requirements for servicedevelopment. The Department estimatesthat nationally around 300,0008 extraAHS complete pathways (where 85% ofaudiology long waits lie) would beneeded between April 2007 andDecember 2008, on top of existing levelsof NHS provision, to make a maximumwait of 18 weeks from referral totreatment possible for all audiologyreferrals, thereby eliminating entirely therisk to 18 weeks described above. Thisimplies an increase in AHS annualprovision nationally of between a thirdand a half, depending on how quickly itcomes in over the 21-month period toDecember 2008. Each SHA, based on thework of its PCTs, will have its ownestimate of the capacity gap associated

with its long waits and the needs of itspopulation.

20. Commissioners will choose to fill theirestimated capacity gap with acombination of greater efficiency inexisting services where possible, and,where that is insufficient, new capacity.The current NHS planning process for2007/8 and 2008/9 for completion bythe end of March 2007 is addressing this.

21. Each PCT will have its own relativeservice priorities, to be set out in its‘prospectus’ to signal the strategicdirection for local services, highlightingcommissioning priorities, needs andopportunities to service providers,offering a focus for discussion withpatients and local communities and anopportunity to open dialogues withpotential providers and with associatedsupporting services. Audiology should beexplicitly addressed through the processof PCTs developing their firstprospectuses.

22. PCTs will want to be clear about theservices and service specifications theyand their practices and patients want tosee developed and will give strategicsupport to proposals where necessary.They will seek to develop improvedpathways and will work with NHS trusts


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8 This estimate is based on available data and recognition of the uncertainty about future demand


and NHS foundation trusts, GP practices,neighbouring PCTs, IS and third sectorproviders, social services and localauthorities as appropriate (e.g. for morecomplex cases such as patients withco-morbid conditions already accessingsocial services) to ensure that theyprovide the most effective, responsiveand efficient services for their localpopulations.

23. At present, NHS audiology services aremostly located in NHS acute hospitals,although some, for children in particular,are provided on an outreach basis in thecommunity. Older people make up alarge proportion of hearing aid users andthe National Clinical Director, in hisrecent ‘Recipe for Care’ report identifiedthe need to bring care closer to homeand to provide early intervention andassessment for older patients withhearing problems9. A small number ofaudiology services are provided by PCTsin primary care settings. Independentsector provision is growing, with someinvolvement in NHS provision through aPublic Private Partnership over the last 5years. The third sector is also involved inpatient support in some audiologyservices.

Case study – voluntary sectorservice provision

Hearing Concern10 uses a network ofvolunteers to support NHS audiologyservices across the country. The volunteersprovide rehabilitative advice to helppatients live with and manage their hearingloss. Whilst currently small scale, thisproject illustrates the role that the voluntarysector can play.

24. For the years ahead, the Department hasalready facilitated the procurement onbehalf of SHAs of 42,000 new pathwaysper annum as part of the Phase 2 ISdiagnostics procurement, due to come onstream from April 2007. The Departmenthas also prepared a Phase 2 IS electiveaudiology procurement on behalf ofSHAs, with the amount to be procureddependent on the outcome of the currentplanning process.


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9 ’A Recipe for Care – Not a single ingredient’ (January 2007)http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4142425&chk=8v8oMf

10 Hearing Concern is a national charity working for people who are deaf or hard of hearing


http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4142425&chk=8v8oMf

Case study – Independent Sectorprovision of NHS audiology services under

current Public Private Partnershipcontractual arrangements

An independent sector hearing aid servicesprovider is working in partnership with amajor NHS teaching hospital trust in theWest Midlands as part of arrangements tomanage NHS patients who require ahearing aid. The company provides around15 clinics per week to the trust, and iscurrently contracted to deliver NHS hearingaid services to over 1500 of the trust’spatients. The clinics are based both in thehospital and high street settings in orderto provide flexibility to the trust’s patients.The partnership approach within thecontract also includes joint-working onpatient-related administration betweenthe company and trust in order to increaseefficiencies.

25. By April 2007, PCTs will agree contractswith local secondary care providers foractivity levels in 2007/8 includingaudiology activity (in the non-PbRschedule). The new national healthcontract focuses on the delivery ofservices within 18 weeks, with financialincentives and good contractmanagement to drive delivery.

26. Commissioners are responsible forcommissioning the right pathways fortheir patients and for ensuring that theyrepresent best value. It is clear that thereis enormous scope nationwide to cutunnecessary waiting out of pathways.At present, AHS pathways tend toinvolve separate visits for assessment,fitting, follow-up, repair and ongoingadvice and counselling. To improvepatient convenience and speed up accessto fitting, and to make more efficient useof audiologists’ time, one-stopassessment and fitting has been trialled ina number of 18 week physiologicalmeasurement development sites,including Norwich, Birmingham, NorthStaffordshire and Leeds. While long waitsremain in some of these trusts, positiveresults are being seen with additionalcapacity being liberated.


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Case study – one-stop assessand fit at Norfolk and Norwich University

Hospital Trust

Norfolk and Norwich University HospitalTrust has been trialling new ‘open-ear’technology, which enables the patient toleave their initial appointment with ahearing aid fitted. The technology is basedon an open ear mould hearing aid tip,which fits most ears. Further efficiency isachieved by using an audiology assistant tocarry out the final parts of the fitting andsecretaries to make follow up calls topatients using a structured questionnaire.

The trust has seen referral to treatmentwaiting times for new patients fall from28 weeks to 21 weeks in the last year andfor those re-entering the service forre-assessment and fitting of a digitalhearing aid from 25 to 11 weeks. Theaudiologist involved has increasedproductivity by 15%. Patients are pleasedboth with the speed and the newtechnology which is more cosmeticallyacceptable. The trust now plans to trainother staff members and to extend thesolution to all suitable patients.

27. To inform local commissioning, theDepartment will publish model carepathways that draw on innovation andgood practice and give localcommissioners clear blueprints as astarting point for the design andprovision of local services. The adult

hearing loss pathway will be published inMarch 2007, glue ear in April 2007 andcochlear implant, balance, bone-anchored hearing aids and tinnitus byOctober 2007.

28. The adult hearing loss pathway willexplain that:

• appropriate new and returningpatients should receive one-stopassessment and fitting based onavailable technology;

• preparation (e.g. removal of earwax)should be carried out in advance inprimary care or as part of the one-stop appointment;

• follow up and reviews, including forreassessments, could be conductedby telephone, postal questionnaire orin person by an audiology assistant;

• patients who have received an aidshould get maintenance, batteryreplacement, and advice fromlocations convenient to them in linethe Care Closer to Home programme,which could involve the third sectoror IS provision on the high street;

• patients that still have an analogueaid should be prioritised for areassessment of their hearing loss andbe provided with a digital aid aheadof those who already have a digitalaid.


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29. The impact of these measures locally interms of increased productivity andpatient experience will depend partly onthe existing service models employedlocally. The Department believes that it ispossible to increase adult hearing losspathway productivity significantly usingthis kind of approach.

30. As well as insisting on best practicepathways, commissioners can derivefurther extra value by requiring betterreferral practice and better waiting listmanagement. Model protocols will bepublished shortly to ensure that patientswho need to be referred are referred tothe right kinds of services (e.g. directaccess, ENT) and that patients who donot have an aid are prioritised. There isanecdotal evidence that the 20% of adulthearing loss cases that are referred toENT could be reduced with more referreddirect to audiology.

31. Experience of waiting list ‘validation’ foroutpatients and inpatients suggests thatcommissioners can derive up to a 10%reduction in list size. Unvalidated listsinclude the details of patients who, forexample, no longer require the service, orwho have moved and are duplicated onmore than one list. Validation of listsenables more efficient use to be made ofavailable capacity because the details of

patients are accurate. Early triage thenhelps to better prioritise patients on thebasis of need and waiting time. We willreview whether new or additionalguidance is needed on waiting listmanagement, and disseminate bestpractice experience with practicalexamples of how it can be done.

32. Commissioners may also require providersto employ the ‘priority treatment list’(PTL) approach to manage their waitinglists. A PTL tool has been designed anddisseminated11. This requires local servicesto list the details of patients waiting for aroutine assessment in order of the date onwhich they were referred for the test andthen to call patients for their tests in thatorder, ensuring openness and fairness. An‘assess & fit’ PTL will be piloted to enableall adult hearing service pathways to bemanaged on a referral-to-treatment basis.

33. All of these measures can serve toincrease efficiency and free up capacity.

34. Proposals for quality assessment andmonitoring, with an agreed minimumspecification, will be developed during2007 to underpin a growing variety oftypes of provision. Linked to this, aservice-monitoring tool similar to the‘global rating scale’12 used for endoscopyservices will be piloted. This will help


10

11 accessible to SHAs on Steis12 http://www.grs.nhs.uk/


http://www.grs.nhs.uk

practices and PCTs to commission on thebasis of quality in its broadest sense,assessing each local service on a rangeof factors such as quality, safety andeffectiveness, responsiveness andefficiency. It may be possible for thelowest performing services to benchmarktheir performance against higherperforming services.

Choice35. Empowering patients to choose a

provider is proven to improve servicesand reduce waits. Choice-at-six-monthsfor orthopaedics was a key factor indriving down inpatient waits in thatspecialty, and the choice-of-scaninitiative, tied to set waiting timemaximums, has had a clear impact onwaiting times for MRI and CT scans.Policy on choice at referral at presentapplies to all referrals from GPs to firstconsultant outpatients, includingaudiology referrals to ENT.

36. Version 4.0 of Choose and Book, forrelease in 2007, is being designed toenable direct referrals to audiology servicesand booked appointments for patients tobe made from GP surgeries. This heralds abroadening of choice-at-referral which willenable patients to choose from a range ofaudiology providers.

37. The Department has already publishedits clear priorities for 2007/8 in theOperating Framework. However, we willkeep under close review the possibility ofintroducing a choice-of-scan-typeapproach for audiology (choice ofaudiology service) later in 2007/8 or fromApril 2008 when the extra IS capacityprocured on behalf of the SHAs and theirPCTs is likely to have come on stream.

Local prices38. The Department will look to develop

benchmark costs, and is committed toconsidering the introduction of nationalaudiology tariffs as soon as practicablebearing in mind the recommendations ofthe Lawlor review of payment-by-results.In the meantime, local commissioners willwant to work with their providers togenerate the conditions for choice andcontestability to flourish. The absence ofnational tariffs in this area means thatPCTs are empowered to do this anddevelop prices that support choice andefficiency, rather than block contracts.

Information39. The publication of information is a

powerful driver of patient choice andpeer opinion. Until recently there was noavailable information on audiologyservices. Since the middle of 2006, NHSdata on waits for audiology assessmentshas been published by the Department13,


11

13 http://www.performance.doh.gov.uk/diagnostics/index.htm


http://www.performance.doh.gov.uk/diagnostics/index.htm

and this will continue. In the spring, theDepartment will begin to publish NHSreferral-to-treatment (RTT) data coveringthose audiology pathways that are within18 weeks. As local services will need torecord RTT times for 18-week patients, itwould make sense to record RTT timesfor all audiology patients. We willconsider whether a national datacollection of all audiology RTT times isnecessary.

40. To support active choice, information onhealth services needs to be presented topatients in clear and engaging formats.We will ensure that comparativeinformation is made available on the“healthy choices” website, which isexpected to go live in the summer.

41. The achievement of 18 weeks will bejudged, not just by RTT data but by whatpatients actually experience of theservices they receive. That means theirexperience not just of access but ofquality, safety and other factors. A set ofpatient experience metrics by which tojudge 18 week achievement in eachlocality is being developed. We intendthat this will cover audiology servicesincluding direct access services.

Spread of good practice42. The Department will help by making

available audiology good practiceinformation and tools in various areas,including evidence which has beengathered from nine NHS developmentsites as part of the 18 weeksphysiological measurement programme.All evidenced good practice will continueto be made available onwww.18weeks.nhs.uk and disseminatedwidely by other appropriate routes.

43. SHAs are encouraged to operateaudiology networks of clinical leaderswith IS and third sector representatives,to help with the spread and adoption ofgood practice.

Case study – West Midlands SHAaudiology network

West Midlands SHA has established anetwork of providers of audiology servicesto share ways to address long waitingtimes. The network is sponsored by theSHA Director of Commissioning. Heads ofaudiology Departments and PCTCommissioning Leads get togetherquarterly to consider the use of sparecapacity – for example moving patientsacross PCT boundaries – and usingalternative providers in the NHS and IS.


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http://www.18weeks.nhs.uk

44. SHAs and PCTs should pilot and evaluatetheir own new and innovative ideaswhich in some cases the Department maybe in a position to sponsor.

Workforce tools45. Workforce is critical to implementing this

framework. Plans must be affordable,and should be supported by significantrole redesign, skill-mix and productivitygains. Providers will want to considerdeveloping competence based models ofthe current and the future workforcewith emphasis on tackling blockages inthe pathway and developing alternativeprocesses where there are shortages.It is also beneficial to ensure that financialplanning for training supports thestrategy and that new MPET flexibilitiesare used and that vacancies, for example,are seen as opportunities for skill-mixchanges rather than insurmountableblockages.

46. Most importantly, it is crucial that localstaff are engaged with service andprocess redesign and that local leadersand clinical champions are identified.Support is available in the NationalWorkforce Projects directory ofresources14.

47. A toolkit of materials will be developedto support local health systems inadjusting workforce profiles to reflect thenew model pathways and volumes ofactivity required. It will include a surveyof the current workforce and roles,modelling based on the new pathways,including of associated new roles andunderpinning competencies andidentification and development ofsupporting education and training for useby SHA and PCT workforce planners andcommissioners. At present, skill mix andnumbers of staff vary betweenorganisations and settings but withoutobvious correlations in terms of outputs.

48. This year over 300 new hearing aidaudiologists will be trained by HigherEducation Institutions to respond todemand from High Street hearing carepractices. They will complete aFoundation degree operated as an “earnas you learn” partnership with high streetemployers. Over two years, this degreeprogramme will combine academic andworkplace learning and skillsdevelopment. This work has beeninformed by and will align with a broaderDH programme of work to modernisescientific careers, linked to skills andcompetence development as part of theskills for health work programme.


13

14 www.healthcareworkforce.org.uk


http://www.healthcareworkforce.org.uk

Summary of key outputs49. Key outputs, as they appear in the

document, are:

• Expert working group – foreword(ongoing)

• Model care pathways – para 27(March – October 2007)

• Referral protocols – para 30 (May2007)

• Waiting list management bestpractice – para 31 (May 2007)

• Assess and fit PTL pilot – para 32(by end 2007)

• Quality assessment and monitoring –para 34 (by end 2007)

• Service-monitoring tool – para 34 (byend 2007)

• Choose and book for audiology –para 36 (2007)

• Decision on choice of audiologyinitiative – para 37 (2007/08)

• Benchmark costs developed – para 38(2007)

• Decision on tariff for audiology –para 38 (2007)

• Decision on data collection foraudiology RTT – para 39 (2007)

• Information for patients on “healthychoices” website – para 40 (2007)

• 18w patient experience metricsincluding audiology – para 41 (2007)

• Good practice information and tools –para 42 (March 2007)

• Workforce toolkit – para 47 (Summer2007)


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improving access to audiology_[1]

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