Independent Review of Audiology Services in Scotland

Executive summary

In January 2022, the Cabinet Secretary for Health and Social Care announced that an Independent National Audiology Review (the ‘Review’) would be established to examine hearing services provided to children and adults in Health Boards across Scotland and to make recommendations on improvements to services.

The Cabinet Secretary commissioned the Review because of failings identified in standards of care provided by the NHS Lothian Paediatric Audiology Service. This followed an independent review by the British Academy of Audiology (BAA), which revealed significant failures in the care of 155 children.

Membership of the National Audiology Review Group and its terms of reference are detailed on the Review website (1). The Review Group consisted of key stakeholders from across the clinical pathway. Patient views and experiences were central to the Review, and an extensive public engagement exercise was undertaken by the Health and Social Care Alliance Scotland (the ‘ALLIANCE’) (2).

The Review focused on key areas critical to the delivery of quality audiology care and outcomes for people living with hearing-related conditions. These areas were:

• structure, governance and leadership of services;
• education and training of audiology staff;
• quality assurance of services.

A range of methods was employed including questionnaires to Health Boards, assessment of some Key Performance Indicators (KPIs) and some patient-level sampling.

The Review identified a range of concerns in all the areas scrutinised. A combination of factors is responsible, but in particular there has been a lack of profile, national oversight, accountability and clarity around Health Board-level clinical governance arrangements. There has also been an absence of national leadership, strategic planning and workforce planning.

In recent years there has been no quality assurance of services, despite the existence of national quality standards for paediatric and adult audiology services. In addition, there is clear evidence of workforce shortages, limited access to undergraduate and postgraduate training programmes and few opportunities for continuing professional development (CPD) and skills maintenance and acquisition once in post.

There are multiple, systemic problems within audiology services in NHS Scotland. Resolving these requires a whole-system approach. The wide-ranging recommendations in this report provide the foundation for improvements that will ensure high-quality, joined-up, patient-centred services.

Implementation of the Review recommendations will require the establishment of an Implementation Board, with expertise from across the patient pathways and, most importantly, patients. The Implementation Board must report directly to the Scottish Government and have the necessary delegated authority and project management support to be effective.

We believe that the recommendations detailed in this report will not only improve the quality of audiology services in the short term, but also provide the structure, governance and leadership required to bring sustained improvement to services.