Independent Review of Audiology Services in Scotland

Structure and approach

The Cabinet Secretary for Health and Social Care appointed Professor Jacqueline Taylor as Chair of the Independent Review, working alongside Mr John Day, Head of Audiology, Betsi Cadwaladr University Health Board, NHS Wales, as Vice Chair. Full membership of the Review Group is available on the Review website (1).

A Reference Group and three Sub-Groups were established to fulfil the Review Group’s remit. The areas of focus for these were as follows.

• The Reference Group, chaired by Mrs Angela Bonomy, Chief Executive Officer, Sense Scotland, was tasked with ensuring stakeholder views were understood and properly considered during the Review; and that the recommendations captured the lived experience of people with sensory loss and their carers and families. A section providing detail on the role and work of the Reference Group can be found under People at the Centre, below.
• Structure, Governance and Leadership, chaired by Mr Adrian Carragher, Head of Audiology, NHS Ayrshire and Arran.
• Education and Training, chaired by Dr Robert Farley, Associate Director – Healthcare Science, NHS Education for Scotland;
• Quality Assurance, chaired by Mr John Day, Clinical Director of Audiology, Betsi Cadwaladr University Health Board, North Wales.

The Review Group’s membership reflected key stakeholders across the clinical pathway, with expertise from a wide range of stakeholders including NHS audiologists, heads of service in audiology, NHS Education Scotland (NES), Newborn Hearing Screening Scotland, the Scottish Cochlear Implant Programme (SCIP), Hearing Impairment Network for Children and Young People (HINCYP), Healthcare Improvement Scotland (HIS), the British Academy of Audiology (BAA), the British Society of Audiology (BSA), National Services Scotland (NSS), the National Deaf Children’s Society (NDCS), the Royal National Institute for Deaf People (RNID), the British Association of Paediatricians in Audiology (BAPA), and Sense Scotland. Secretariat support for the Review was provided by the Chief Nursing Officer Directorate (CNOD) in the Scottish Government.

The involvement of expertise from outside Scotland was essential to provide an external perspective. Conflict of interest guidance was produced and members invited to complete a declaration.

The core principle adopted throughout the Review was that of “learn, not blame”. It was essential to have wide stakeholder engagement and that, moving forward, all stakeholders should have joint responsibility for delivering change.

The Review Group met nine times every six to eight weeks, with the Sub-Groups and Reference Group meeting regularly between the Review Group meetings.

Sub-Group chairs provided regular updates at each Review Group meeting. Further details of methodology and the findings and recommendations from the individual Sub-Groups are described later in this report.

Recommendations, which were time sensitive, were produced as the Review progressed. Any concerns identified in terms of performance issues were escalated to for appropriate intervention with Health Boards.

Throughout the Review, we grappled with its scope and with the level of detail of enquiry. There were so many areas worthy of exploration and examination. The Review considered current models of service provision, investigating the structures, resources and quality assurance to deliver them. It has not explored or commented upon new models of service. While this is not an exhaustive review the approach we have taken is proportionate to the time and resources available to us.

We heard from all quarters of the importance of ensuring that systems and structures are put in place to ensure continuing improvement of services.

It is vital to emphasise that the Review report 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.

The Review is not a needs assessment for audiology services in Scotland, nor is it a workforce plan, though there are references throughout the report to the importance of having sufficient staff with the requisite competencies and skills to provide safe, high-quality services. The independent sector was also felt to be beyond our scope and our focus is very much on current NHS provision.