Independent Review of Audiology Services in Scotland

Engagement with audiologists

Key points

A survey was conducted to gather the views of NHS Scotland audiologists on a number of key areas, including training, leadership and quality of care.

• Respondents felt training opportunities were limited by lack of funding, workplace pressure and staff shortages.
• Lack of national leadership was a key concern.
• Audiologists’ views on the quality of services varied widely, with most commenting on a need for more staff.
• High-quality training and work-based learning were seen as priorities.
• A workshop for service leads revealed particular concerns about increasing workload and complexity of patients.

The Review was keen to hear the views of audiologists working in NHS Scotland. The BAA conducted engagement work with audiologists by means of an anonymous online survey (7) and a number of focus groups. We felt it was important that this work was undertaken independently, by a professional organisation for audiologists, to encourage them to speak openly.

While audiologists have been key members of the Review and its Sub-Groups, we were keen to seek the views and experiences of as wide a range of NHS audiology professionals as possible. It was important for the Review to receive their feedback and suggestions. The Review is grateful to the BAA for conducting this work.

The BAA survey, approved by the Review Group, included questions on training, leadership, career opportunities, raising concerns and quality of care. Workshops were also conducted to explore questions in more depth.

The response rate was approximately 25% of those currently working in bands 3 to 8 and the majority of respondents had been working in audiology for more than 10 years.

In terms of training and education, respondents reported that opportunities were mainly internal, with very limited external training due to lack of study-leave funding, service pressures and workforce shortages.

Audiologists felt that a lack of leadership nationally in the specialty, and within their own departments, was a key issue and that more effective succession planning was required.

Most respondents reported having very limited career development opportunities, and again those available were mainly in-house. Forty per cent of those who participated had never had an appraisal and those who had reported that it was largely a “tick-box exercise”.

There was a range of responses to questions about audiologists’ perceptions of the quality of their service, from “excellent” to “awful”, though respondents typically commented that staff were very caring and dedicated. In terms of suggested improvements, most respondents commented on the need for more staff, better training and, in some cases, better facilities and equipment.

The workshops delved more deeply into some of the themes outlined above. Participants reported that there had been significant changes in audiology service provision in the last decade. They voiced concerns about the withdrawal of undergraduate training programmes, lack of access to specialist training, increasing workload and complexity of patients, and little investment in service development.

They viewed the provision of high-quality training programmes and work-based learning options as a priority. In addition, they were keen to see the development of communication networks between professionals to build connections and share learning. Improved access to external training and funded study leave were viewed as important, along with opportunities for appropriate career development.

Similar themes were explored in a workshop for service leads to determine the experience of those in leadership roles. They were particularly concerned about increasing workload, increasing complexity of patients and widening of the scope of practice of audiologists without proportional increases in workforce or resourcing. They reported that the composition of the audiology workforce has changed, with fewer having BSc or master’s level qualifications. The withdrawal of BSc audiology programmes and lack of specialist training in broader healthcare science degrees were viewed as important issues. Services are struggling to recruit and retain qualified staff, and in paediatric audiology this is compounded by workforce shortages within speech and language therapy and teachers of the deaf.

There was a general perception that Health Boards lacked interest in audiology services and that there was a lack of support for service development. Service leads also identified the lack of national oversight by a national advisory structure as a key factor and one which should be rectified.

The views and suggestions of audiologists have been carefully considered in the development of our recommendations.

This quote from one audiologist is particularly poignant.

“Much of audiology in Scotland is currently paralysed by an abject lack of vision, funding and leadership from the highest levels of government and health service management over the last decade. It is my assertion it has not been a favoured valued or prioritised profession. Lack of training of new audiologists, lack of promotion of our profession, and lack of planning for staffing levels has seriously impacted on succession and staffing levels. Budgetary limitations, both nationally and locally, have resulted in some services being run to breaking point. The number of highly skilled and qualified audiologists leaving the sector completely in the last few years represents a waste of talent, and an abject failure of vision and leadership from the highest levels of health service governance. Morale is at an all-time low, and unless positive change is forthcoming soon the ‘walk away’ will continue. The heads of service will have expressed their concerns over the years. But leadership from above is essential.”