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Report on children’s audiology services is a “first step in the process of change”

Publication: The Orkney News

Commissioned by Scottish Government Ministers in January 2022, following concerns raised about the standards of care provided by NHS Lothian Paediatric Audiology service, The Independent Review of Audiology Services in Scotland has made 55 recommendations for improving Children's Audiology services in the country.

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An Independent Review of Audiology Services in Scotland has made 55 recommendations for improving governance, structure, education, and leadership.

Scottish Government Ministers commissioned the Independent Review of Audiology Services in Scotland in January 2022 following concerns raised about the standards of care provided by NHS Lothian Paediatric Audiology service. There was then an independent review of NHS Lothian Paediatric Audiology Service carried out by the British Academy of Audiology, which published its final report in December 2021.  Professor Jacqueline Taylor, MBE Independent Chair, said:

“While the Review found examples of good practice, there are many areas ripe for improvement, and there is a huge appetite for change. We firmly believe that implementation of the Review recommendations is an opportunity which must be grasped to ensure the development of sustainable, high-quality Audiology services for everyone in Scotland.”

Commenting on the findings of the report, Mark Ballard, Head of Policy and Influencing for Scotland at the National Deaf Children’s Society, said:

“This report paints a deeply concerning picture of the state of audiology in Scotland. Parents who rely on audiology services for their children will be shocked to learn there has been an absence of national leadership, strategic planning and workforce planning at audiology departments across Scotland and that there has been no quality assurance of services in recent years.

“It is alarming that issues were identified in the quality of ABR testing at every single health board across Scotland.”

Table of Patient to Staff Ratio in Scotland 2023 from Appendix C Independent Review of Audiology Services in Scotland

There are approximately 3,600 children in Scotland with Hearing Loss. The picture across Scotland was patchy, with some Health Boards providing ‘highly quality’ audiology services.  

The report makes clear that it ” is absolutely not an end in itself; it is merely the first step of a process of change that will take time, resources and leadership to deliver.”

There is no single body in Scotland which oversees the delivery of all paediatric and adult audiology services or has responsibility for them. This has resulted in a complex mixture of services and inconsistent, even poor care.

All of NHS Scotland’s 14 territorial Boards deliver the service. In two Boards, paediatric and adult services are separated. In addition, and due to a historical arrangement associated with the management of the service, Argyll and the Isles has been included as a separate service delivering audiology services in that geographical region, although it is formally part of NHS Highland. Some of these are struggling with staff shortages (national vacancy rate 10%) or have very few employed. This means that in Scotland, the service as a whole is “about 65% of that required for a safe and effective service.”

Mark Ballard of the National Deaf Children’s Society said:

“We know deaf children can achieve anything that hearing children can when they get the right support, but for this to happen their deafness must be identified at the earliest opportunity. This is why it is vitally important that children always receive high quality and effective testing and long-term support. 

“Parents need reassurance that issues with the quality of services will be swiftly addressed. This report was commissioned after significant failures were uncovered at NHS Lothian involving more than 150 children over nine years. Some of those children experienced life-changing consequences, because their deafness was identified too late for them to get the surgery or communication support they needed. There must be no more similar failures. 

“Parents told the review about the difference a good audiologist can make and it is clear from this report we need to make sure they always have the resources, training and leadership required to deliver effective support. 

“It is now crystal clear to the Scottish Government and NHS health boards what they must do to make sure every child gets the testing and support they need.”

Among its recommendations, the report states that there needs to be one nationally recognised body with a remit to oversee quality assurance across the service. Those working within the service recognise the need for improvements, but the service is under-resourced. The continuous professional training of existing staff and encouraging more students to take up courses currently available are required. The report concludes that there needs to be the urgent establishment of an Implementation Group, which includes patients and the Third Sector, to take forward the recommendations. Independent Review of Audiology Services said:

“This is not the time for a half-hearted response or for a sticking-plaster approach. This is a time to acknowledge the systemic issues and to use this report as the catalyst for a transformation process, which will require vision, national leadership and accountability.

“It will require planned investment in the education and training of our audiology professionals to ensure the right numbers are available with the required skills. In parallel, it will require the establishment of robust, quality assurance processes for services to affirm the delivery of high-quality care.”

Professor Jacqueline Taylor MBE, Chair of the Independent Review, said:

“The wide-ranging recommendations in this report provide the foundation for improvements which will ensure high-quality, joined-up, patient-centred services. Audiology staff are working incredibly hard, often in challenging circumstances and during the course of the Review process we have seen many examples of good practice.

“We have also identified a range of issues which need to be resolved. I am extremely grateful to the patients, parents, audiology staff and stakeholders who helped to shape this Review. We have listened carefully, and I believe that by working together, we have a real opportunity to develop  excellent services across Scotland.

“The Review Report is not an end in itself: it is the first step in a process of change which will require time, resources and national leadership to deliver. We hope that the Scottish Government will respond positively to the recommendations and will  ensure that the words in this report, are turned into actions.”

Jenni Minto is the Scottish Government’s Public Health Minister. She thanked all those who took part in the report and said the next steps to take the recommendations forward would be presented to the Scottish Parliament in the coming months’.