Independent Review of Audiology Services in Scotland

Introduction

Hearing loss has a significant impact on people at every stage of life: for infants and children, failure to identify it can have lifelong consequences for development of language, and for cognitive, emotional, educational and social development. Early identification and effective management are essential to allow children to attain their full potential.

Every step of the care pathway must be effective, timely and coordinated. There is an international evidence base showing that newborn hearing screening, if followed up by timely and appropriate diagnostic assessment, medical and audiological management, and family support to aid communication development can significantly improve outcomes and opportunities for children with hearing loss. The importance of seamless transitions of care and effective multidisciplinary coordinated care are emphasised in international guidelines (3).

While there are very time-sensitive issues in terms of identification and management of hearing loss in infants and children, hearing loss in adults can have an enormous impact on life in general, and on quality of life in particular. It can affect ability to work, which has potential economic implications. It can impact on the ability to participate in and manage activities of daily living. Hearing loss can also have a huge adverse effect on socialisation, leading to social isolation. There is also growing evidence that in older adults, hearing loss increases the risk of developing cognitive decline and dementia (4), with all the associated adverse health and socio-economic outcomes. The principles of seamless, integrated care across the patient pathway are equally applicable to adults.

Identification, assessment and management of hearing loss are therefore essential across the age spectrum. Audiology services play a key role in this, but do not work in isolation. They have important links to other healthcare services, education, employment and the third sector. They require an organisational structure and oversight to function effectively.

During the course of this Review, we have learned that audiology services are historically lacking in profile. Audiology professionals feel strongly that they belong to a specialty that is poorly appreciated. At a time when NHS Scotland is facing unprecedented and unrelenting pressures, audiology must compete with other sectors for finite funding and resources.

Hearing loss is common; in fact, it is one of the most common disabilities in the UK. In 2015, Action on Hearing Loss estimated that there were 945,000 people with hearing loss in Scotland – one in six of the population (5).

The presence of hearing loss rises with age: it is estimated that 70% of over 70s have some degree of hearing loss. Given the demographic changes in our population the prevalence of hearing loss will have increased since 2015 and will continue to rise.

There are approximately 3,600 young people in Scotland with hearing loss: it is estimated that 1.1 children per 1,000 are born with permanent bilateral deafness and 0.6 per 1,000 are born with unilateral deafness (4).

The Scottish Government’s See Hear Strategy (4) provides a strategic framework that applies to children and adults living with a sensory impairment in Scotland. The aims of the strategy include the seamless provision of assessment, care and support to children and adults with a sensory impairment; and the assurance that they should expect the same access to education, employment and leisure as everyone else.

In addition, the strategy states that children and young people with a sensory impairment should expect appropriate and timely intervention in the early years and for as long as is required; and that people with a sensory loss should be able to access information and be supported to live as independently as possible.

• In 2015, Action on Hearing Loss estimated that there were 945,000 people with hearing loss in Scotland – one in six of the population
• It is estimated that 70% of over 70s have some degree of hearing loss
• There are approximately 3,600 young people in Scotland with hearing loss