General election 2017: Uninspected audiology services

Beccy Forrow Policy and Campaigns Officer

Beccy Forrow, Policy and Campaigns Adviser

Would you send your child to a school that hadn’t been inspected by Ofsted? Would you ride in a car that didn’t conform to industry safety standards? Would you eat in a restaurant that refused to take part in food hygiene inspections? All questions I’d answer no to.

But this is what is being allowed to happen with children’s audiology services in England. Only 15% of services have been inspected and achieved a high enough standard to become ‘accredited’. This leaves the majority of services uninspected – with deaf children, young people and their families having no idea whether they are attending a great service or one that is poor quality and unsafe.

Considering that an NHS report in 2014 found that one third of audiology services were failing to meet critical NHS quality standards, with no incentive to improve, it’s unlikely that many will now be providing a better service. This matters because hearing is critical to a child’s development of language and learning. Early diagnosis and support reduces the risk of delays in language, educational, social and emotional development. But this support needs to be consistently of good quality.

Earlier this year we created an audiology map so that parents could check if their local service had reached a high enough standard to be accredited. However, of 134 services, 40 have so far refused to take part in the inspection scheme at all. Many others have registered for the scheme but not moved closer to an inspection visit over the course of the last few years.

We’re calling on the next Government to make it compulsory for all children’s audiology services in England to take part in the inspections so that parents can be confident that they are fit for purpose. As the inspections cost money and can be time consuming to prepare for, it’s vital that the Government levels the playing field by making the inspections mandatory for all services. Audiology services for deaf children won’t get better on their own.

If any general election candidates come to your door, be sure to ask them about the quality of children’s audiology services. We’ve got some other questions you might like to ask them on our election web page.

Cast a spell on the inspectors…

Sophia-James-cropped

Sophia James, Policy and Campaigns Officer, National Deaf Children’s Society

With the evenings darkening as winter creeps in, the inspectors aren’t wasting any time. Round two of the Ofsted and CQC inspections into special educational needs and disabilities (SEND) has kicked off faster than a Boxing Day sale (yes, the shops already have their Christmas stock in). Feeling the need for speed, the inspectors have visited five local areas in the first month.

If you’re lucky enough to live in Herefordshire, Bexley, Hartlepool, Plymouth or Surrey, you’ve already had a visit. We’re curious to know if you had any idea the inspections were taking place? Did you get involved? Give your feedback here.

Cast your spell

 If your area hasn’t been visited yet, you still have the chance to talk to inspectors about the support you get locally. All towns and cities will be inspected within the next five years, so don’t miss your opportunity to cast a spell. To find out more about what you need to do, check out The Buzz if you’re under 18 or have a look at our website.

 Trick or Treat

Reports from the first set of inspections were released over the summer holidays. Initially, in our view, the reports consisted of broad, general statements about SEND services across education, health and social care. Only four out of the seven reports released gave any specific mention of deafness, and even then, these were rarely detailed references to services.

That said, there are certainly some treats in these reports; they are the first ever focused reports into SEND services at a local level. In some reports, the inspectors have demonstrated they are listening to parents of deaf children and flagging up their concerns. Ofsted and the CQC are also making efforts to alert people to the fact these inspections are taking place on social media.

With Halloween fast approaching and reports soon to be released, it’s worth asking the question – will this next set of reports hold more tricks or treats for deaf children and young people?

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Your chance to improve communication with health services in Wales…

Debbie Green, Policy & Campaigns Officer Wales

Debbie Thomas, Policy and Campaigns Officer, Wales, National Deaf Children’s Society

In my eight years with NDCS Cymru, I have heard many stories about a shameful lack of deaf awareness at doctor surgeries and other health services. For example, deaf people being called verbally for their appointment and missing it, patients missing key information about their illness because their doctor is not deaf aware, and parents being asked to act as an interpreter for teenagers who would really prefer to keep their appointment private. 

But it is not all doom and gloom – the good news is that Public Health Wales is keen to do something to address this issue. In fact, it is setting up a group to advise on how best to collect information on patient communication needs.

 Do you (or does someone you know) fancy joining this group to have your say and make a difference? Find out more here.

 

 

 

 

Getting it right from the start

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Today, we’re launching a new campaign in England, called Right from the Start.

NDCS - Ian Noon, Head of Policy and Research

Ian Noon, Head of Policy and Research

The campaign is celebrating 10 years of newborn hearing screening and how this simple and painless test has literally transformed the lives of thousands of deaf babies.

But whilst screening has made a big difference, there is still much that needs to be done. Once diagnosed as deaf, children and their families need high quality support to ensure they can develop the language and communication skills that are the foundations for success in later life.

Unfortunately, it’s clear that this support is not being provided consistently across the country. We know there’s a massive attainment gap in the early years foundation stage, where children are assessed among a range of early learning goals. We also regularly hear from parents that vital support, such as audiologists, Teachers of the Deaf, support with communication and so on is not being provided when it can have the most impact.

We’re calling on the Government, local authorities and health bodies to work together and make a commitment to ensure high quality support is in place as soon as a child is diagnosed as deaf. Our campaign report explains how the benefits of hearing screening at birth are being lost and what action is needed to ensure deaf children get the right support, right from the start.

Join us in getting it right from the start. We’re asking our campaigners to email our report to their MP and to ask them to take action.

There’s lot of other ways you can support the campaign. Find out more at www.ndcs.org.uk/rightfromthestart.

Latest SEN stats raise concerns about impact of SEN reform

NDCS - Ian Noon, Head of Policy and Research

Ian Noon, Head of Policy and Research

Last September, the Children and Families Act 2014 came into force, heralding big changes to how children with special educational needs (SEN) will be supported in education. The Department for Education made a big promise that no child would lose out of support as a result of these changes. One would therefore expect that the number of children getting legal statements of SEN or Education, Health and Care plans to have remained fairly stable over 2014. Instead though, new figures suggest a 6.8% drop in the number being issued over 2014. 20 local authorities have seen reductions of 30% or more.

Education, Health and Care (EHC) plans are replacing statements of special educational needs (SEN). They’re both legally binding documents which set out the support that a child with SEN may need to achieve their potential. EHC plans are intended to be an improvement on statements by ensuring more joined-up support. EHC plans are also available for children and young people up to the age of 25. All statements must be converted to EHC plans by April 2018.

The Department for Education suggest that the decline is partly due to ‘non-statutory’ EHC plans being introduced by pathfinders. These pathfinders are local authorities which volunteered to try out the changes in advance and were able to issue non-legal plans to see how they worked. We took a closer look at the stats to see if this was a potential explanation. But actually, when we stripped out the 31 local authority pathfinders, we found that there was still a 6.3% decline across all other local authorities.

One of NDCS’s biggest concerns from the start was that, whilst many of the changes might be sensible, it was a bad idea to introduce these changes at a time of widespread spending cuts and before a proper system had been introduced to hold local authorities to account for not following the law around SEN.

An NDCS survey of parents of deaf children published in 2013 showed widespread concern about the reforms, with only 6% believing that the changes would lead to better support and 72% thinking the real aim was to reduce spending.

Sadly, it now appears those concerns may be justified and, unless swift action is taken, promises to ensure no negative impact from these changes are at risk of being broken.

If you’re a parent of a deaf child looking for more information about the changes, the NDCS website has a range of factsheets and resources. There is also information for deaf young people on the NDCS Buzz website. For further support, parents can contact the National Deaf Children’s Society Freephone Helpline on 0808 800 8880 (voice and text), email helpline@ndcs.org.uk, or chat online at www.ndcs.org.uk/livechat

NEW Devon CCG abandons plans to ration hearing aids! Four reasons why this decision would have breached the CCG’s statutory duties.

Image of Sarah Collinson, NDCS Regional Director for the South West

Sarah Collinson, Regional Director for the South West

The North East and West (NEW) Devon CCG has confirmed that it has abandoned its decision to ration deaf patients over the age of 18 to just one NHS hearing aid. The policy to restrict hearing aids had been announced in an ‘Urgent and Necessary Measures’ notice issued in December and was intended to affect all adult hearing aid users in the NEW Devon CCG area; the only exceptions would be people with additional sensory disabilities and patients with conditions such as autism ‘where social cues may be particularly important.’

As NDCS supports young deaf people into early adulthood and campaigns for all deaf children and young people to have access to good quality audiology care, the NEW Devon CCG’s moves called for a swift response, not only because it was due to be introduced with immediate effect, but also because other cash-strapped CCGs might be considering similar measures and would be watching the Devon situation closely.

With local campaign action by NDCS members, regional TV news coverage and letters to the CCG and local MPs, we pulled out all the stops to try to convince the CCG to think again. Along with pressure from Ben Bradshaw MP and Action on Hearing Loss, our action seemed to pay off, with the CCG announcing shortly before Christmas that it would suspend the decision to ration hearing aids until the issue had been considered by its Clinical Policy Committee (CPC).

When I discovered that the CCG’s Governance Committee was to look at the issue again in early January, I sent a second letter to the CCG’s Chair outlining our concerns with the proposed policy and highlighting a number of key areas where it would seem to breach the CCG’s statutory duties under the NHS Constitution and the Health and Social Care Act (HSCA). This additional pressure has borne fruit, as just a few days after looking at the issue again, the CCG has announced a complete U-turn, with the rationing of hearing aids now entirely shelved.

In case other CCG’s might have been thinking of restricting adults’ hearing aids in this way, it’s worth highlighting the main reasons why they would be wrong to do so, as I pointed out to the NEW Devon CCG:

  • The CCG is duty-bound under the NHS Constitution and the HSCA to promote equality through the services that it provides and to pay particular attention to groups or sections of society where improvements in health are not keeping pace with the rest of the population. Deaf young adults are already significantly more likely to suffer mental health problems and face higher barriers to education; deaf people are four times more likely to be unemployed that hearing people. Any measure that will compromise their ability to use their hearing as effectively as possible will exacerbate these risks and disadvantage them further.
  • Patients have the right to expect local decisions on funding of treatments to be made rationally following a proper consideration of the evidence. NEW Devon claimed in the Urgent and Necessary Measures notice issued in December that ‘Evidence suggests that correcting hearing in the second ear … is far less cost-effective even though people derive some benefit from it.’ Yet, for 20 years or more, binaural aiding has been universally accepted as the most appropriate and effective treatment for the majority of cases of bilateral hearing loss. Not only would we dispute the apparent cost-savings to be made for the CCG, but we can’t accept that one hearing aid is as good as two. In fact, there is evidence that bilaterally deaf hearing aid users are disadvantaged if they have to rely on one-sided hearing. Hearing with just one ear or one hearing aid leads to problems for the brain processing sounds, understanding speech in background noise and localising the source of a sound.
  • The NHS Constitution also gives patients the right to be given information about the risks of treatment options available. The CCG’s Urgent and Necessary Measures notice didn’t mention the risks of one-sided aiding for people who are deaf in both ears. This would have to be taken into account in any comparative cost-benefit analysis of providing one hearing aid instead of two. Quite apart from the heightened risk of mental health problems and other comorbidities, there is also a risk of monaural aiding of bilaterally deaf people doing harm to the patient by causing non-reversible auditory deprivation to the unaided side. In a significant number of patients, auditory deprivation has been found to be significant and irreversible, and it isn’t possible to predict which patients are likely to be affected in this way.
  • The Health and Social Care Act stipulates that the CCG must make arrangements to ensure that individuals to whom the services are being provided are involved in the development and consideration of proposals where the proposals would have an impact on how services are delivered or the range of health services available. To our knowledge, the CCG conducted no consultation with patients and other stakeholders on possible hearing aid rationing prior to issuing the Urgent and Necessary Measures notice in December. The lack of transparency around the Quality and Equality Impact Assessment that should have been undertaken in advance of making any decisions on this issue  is very worrying, particularly given the substantial negative impacts that hearing aid rationing would have on large numbers of deaf people  across Devon.

We are relieved at NDCS the restriction on provision of NHS hearing aids has been abandoned in Devon, at least for now. However, we will have to remain vigilant going forward, not only in Devon but also nationally, in case other CCGs seek to address financial shortfalls with similarly crude and potentially harmful rationing measures.

Listen Up! campaign update. Email your health commissioner now!

Liz Partridge, Campaigns Manager

Liz Partridge, Campaigns Manager

Email your health commissioner now and ask them to tell you what they are doing to ensure your child’s audiology service is good quality!

A couple of months ago we launched our Listen Up! campaign in response to an NHS report that revealed that one-third of children’s audiology services failed deaf children. We called on you to take action and email your MP to ask them what they were going to do to help ensure that all deaf children receive a good quality audiology service.

I would like to say a massive thank you to the many of you that took action. As a result of your action we secured a meeting with the Health Minister Dr Daniel Poulter and he has agreed to investigate further.

However our work is not done! It is important we continue to take action because we know that one-third of children’s audiology services failed deaf children and despite this the Government stopped inspecting these services. This means we have a very little idea of how children’s audiology services are doing now, leaving many families in the dark about how good or bad their child’s audiology service is.

Listen Up! campaign logo

So we need to keep the momentum going – please take action now and email your local health commissioner to find out more about the quality of your child’s audiology service.

You can also find out more about the campaign and don’t forget you can join our Campaigns Network to be kept regularly up-to-date!

Further updates will be coming your way soon so please keep an eye out and continue to take action to ensure all deaf children and young people receive a good quality audiology service.

Thank you.