Independent Review of Audiology Services in Scotland

History of audiology services in Scotland

Key points

• The landscape of audiology services in Scotland is complex.
• Audiologists have been at the forefront of developing national standards for both adult and paediatric services.
• Despite a number of initiatives over the past 20 years, there has been a gradual loss of focus, leadership and organisational structure in audiology services.
• Audit with external peer review of standards has been uncommon.

The landscape of audiology services in Scotland is complex. To understand the current position, it is important to be aware of the history of the evolution of services over the last 20 years.

In January 2003, the then Public Health Institute of Scotland published a Needs Assessment Report on NHS Audiology Services in Scotland (8,9). Recommendations included the need to develop quality standards for audiology services and the means to assess each service’s ability to meet these standards.

A modernisation project was established to address the key recommendations, with supporting investment over four years to help provide quality digital hearing aid services to patients across Scotland. As part of this work a Scottish Government Audiology Services Advisory Group (ASAG) was established to monitor development of NHS audiology services in Scotland.

An audit of the modernisation process in Scotland using draft standards was commissioned in 2007 and conducted by the Medical Research Council Hearing and Communication Group, University of Manchester. About half of all Health Boards were delivering high-quality adult hearing services, while the remainder were struggling to meet the demands of a modernised service (10).

Although paediatric services, newborn hearing screening, assessment, diagnosis and hearing aid provision were provided, mostly in a joined-up, family-friendly manner in all the Scottish services, there was a concern that the current arrangements for paediatric services lacked sufficient medical, technical and scientific expertise in all areas, and a networked approach was suggested.

Audiologists in Scotland were at the forefront of developing standards. A multidisciplinary sub-group of ASAG developed Quality Standards for Adult Hearing Rehabilitation Services using the then NHS Quality Improvement Scotland standards development methodology (8). A multidisciplinary paediatric subgroup of ASAG then developed Quality Standards for Paediatric Audiology Services (9). The Quality Standards for Adult and Paediatric Audiology Services were formally launched in 2009.

To ensure the standards became embedded in operational practice, an audiology quality improvement Sub-Group of the ASAG was established to monitor trends and improvements across audiology services. The ASAG fully supported ongoing quality improvement across both adult and paediatric audiology services in NHS Scotland.

In December 2011, following a review of all Scottish Government groups and committees, the then Cabinet Secretary for Health and Sport decided that the ASAG would not continue to be Scottish Government-sponsored. It was subsequently agreed that the group should continue as an NHS operational group under the leadership of a chair and audiology modernisation project manager. However, the project manager post was suspended. The ASAG’s disbandment and the loss of the project manager resource undoubtedly led to a loss of focus, leadership and national organisational structure for audiology services.

In 2015, the Scottish Government commissioned a scoping project to explore the current position in relation to paediatric audiology services and to consider and make recommendations for addressing ongoing issues of access and quality.

The project recommended a national managed clinical network for paediatric audiology, which would provide the required level of national leadership, structure, governance and accountability to achieve the necessary improvements, ensuring that every child was identified as soon as possible and had access to services that met NHS Scotland’s Paediatric Audiology Quality Standards.

It was also recognised as an opportunity to maintain the benefits of the previous modernisation project.

The HINCYP was established in 2019 and launched in 2020. Its aim was to support services and families to achieve the best possible outcomes for children and young people in Scotland with bilateral, severe or profound hearing loss, through better access to high-quality specialist care and support. No similar network or body exists for adults.

It is clear that over the last 20 years there have been a number of initiatives that have attempted to improve audiology services for children and adults. They have been both intermittent and piecemeal. A sustained, sustainable and coordinated improvement programme has been lacking and is necessary.

Clinicians in Scotland played a pivotal role in the development of quality standards for audiology services, which have been adopted by NHS Wales.

It is both surprising and disappointing that although Scotland has been at the forefront of these developments, audit of services against these standards has never been mandated in Scotland and that external peer review of quality standards is extremely rare.

The next sections of this report describe the specific work conducted by the Review’s Reference Group and three Sub-Groups and the recommendations which we believe will result in the necessary improvements to audiology services in Scotland. Information from the engagement exercises with the public and with audiologists has been carefully woven into our recommendations.

The recommendations are wide-ranging and cover: the structure, governance and leadership of services at Health Board and national level; education, training and professional development of audiology staff; and quality assurance of services. In addition, there are some very specific patient-focused and patient-driven recommendations.