National Audiology Review Group minutes: December 2022

Attendees and apologies

• Jackie Taylor (JT), Chair
• Robert Farley (RF), NHS Education for Scotland (NES)
• John Day (JD), Clinical Director of Audiology, Betsi Cadwaladr University Health Board, North Wales
• John Marshall (JM), Ears, Nose and Throat Lead, Scottish Government
• Sam Lear (SL), National Deaf Children’s Society (NDCS)
• Susan Campbell (SC), Universal New-born Hearing Screening Programme
• Kathryn Lewis (KL), British Academy of Audiology (BAA)
• Angela Bonomy (AB), Sense Scotland
• Crystal Rolfe (CR), Royal National Institute for Deaf People (RNID)
• Lyn Hutchison (LH), National Specialist and Screening Services Directorate (NSS NSD)
• Agnes Allen (AA), Scottish Cochlear Implant Programme (SCIP)
• Claire Benton (CB), British Academy of Audiology (BAA)
• Adrian Carragher (AC), Scottish Heads of Audiology Group (HoA)
• Catriona Johnson (CJ), National Services Scotland, National Services Division (NSS NSD)
• Sandra McDougall (SM), Healthcare Improvement Scotland (HIS)
• Dr Anne Marsden (AM), Chair of the British Association of Paediatricians in Audiology (BAPA)
• David Comiskey (DC), Scottish Heads of Audiology Group (HoA)

Apologies

• Donna Corrigan (DC), British Society of Audiology (BSA)
• Jim Harrigan (JH), Scottish Heads of Audiology Group (HoA)

Supported by

• Carole Campariol-Scott, Review Secretariat, Scottish Government
• Kim Kennedy, Review Secretariat, Scottish Government
• Laura Sweeney, Review Secretariat, Scottish Government

Official Observers

• Claudine Duff, Scottish Government
• Esther Black, Scottish Government

Items and actions

Welcome and introductions

The chair welcomed all members and advised the group of apologies received. 

Note of previous meeting and published minutes 

The chair advised the group that the Meeting 5 notes were on Objective Connect and asked if anyone had any amendments to make. The group confirmed there were no amendments, and the chair asked the review secretariat to arrange for the notes to be published on the review web page. 

With regards to meeting 3 Notes, the chair advised the group that the changes made to these notes will now be published on the website as a separate addendum. The chair advised the group that the meeting 2 and 4 Notes will be published in due course.

Action: review secretariat to publish meeting 4 and 5 notes on website. Review secretariat to publish meeting 3 amendments on website.

Update from the chair 

The chair informed the group that she met with Tom Ferris, Scottish Government Lead for Community Audiology in October when she provided an update on the review. They also discussed areas of overlap and interface. A follow up meeting in the New Year will be arranged once some draft recommendations are available.

AC added that Heads of Service have been engaging in dialogue with Community Audiology prior to the Review starting and that these conversations have been ongoing since. AC advised Heads of Service are mindful of crossovers with the Review and will raise any conflict of interests. JD added that community audiology is mostly related to adult audiology services and there was a need to be clear about this when referring to community audiology. AC added that community audiology was a term used to refer to the delivering of audiology services closer to home in the Programme for Government. JD added that it could also refer to where someone is seen in the pathway, which may not be necessarily geographical. The chair added it was about accessibility.

The chair also said she was mindful of the fact that that the public and patient engagement exercise may comment on aspects of community audiology even though it is not part of the review remit. AB agreed this may be part of the feedback on geographical needs.

CR added the importance of exploring different models and encouraging conversations and that RNID can be part of them. The chair advised it is helpful to know there are linkages between the two policy areas and noted the positive dialogues taking place.

The chair advised the group the Interim Reporting meeting with the Cabinet Secretary was postponed twice due to parliamentary business and personal issues respectively. She confirmed it has now been re-scheduled for Monday 19th of December. The chair also informed the group that the review secretariat issued a letter she wrote to the Cabinet Secretary earlier this month, asking for an extension to the review until the end of March, which he approved.

The chair had also written a letter regarding the two early recommendations for restarting courses in QMU and GCU in 2023, which the review secretariat sent to the Cabinet Secretary in November. The chair added that she is still to receive a response and that the review secretariat will meet with the CNOD Education team to discuss advice for the Cabinet Secretary.

Action: review secretariat to meet with the CNOD Education team about advice on a response to letter about the early recommendations.

The chair advised the group she attended the Cross-Party group on Deafness on 7 December, when she provided an update on the work of the Review. She added that there were discussions around mask wearing at appointments and the issues these caused with the ability to lip read. The chair advised this may be reflected in the themes coming from the Reference group public engagement exercise.

The chair asked members of the BAA to provide an update on the recent BAA Audiologists survey.

CB advised there were 66 replies to the questionnaires, analysis is still ongoing and expected to be completed by Christmas. Workshops are scheduled in January. AC advised there is a regional BAA event in Scotland on the 6th of February 2023 which isn’t specific to the Review and is independent of the BAA-run workshops but wanted to highlight to promote engagement. AC also advised he plans to include an update on the Review for the event. He asked if the chair or vice chair would be able to speak at the meeting. The chair advised that either herself or the vice chair will be happy to attend.

The group had a discussion around the level of engagement with the survey, with some expressing disappointment at the low completion rate but may be due to current service pressures, and time constraints. CB added that the BAA didn’t have access to all email addresses and were relying on Heads of Service to disseminate. The chair added that Heads of Service have tried to encourage engagement and hoped the workshops will help with further participation. She suggested that communication be issued to NHS Boards Chief Executives to further highlight the importance of engagement. The chair thanked the BAA for their work on the survey.
Action: chair or JD to attend the BAA meeting on 6 February.

The chair updated the group on the recent chairs meeting, whom she informed the group, meet regularly. At the last meeting the chairs discussed the NHS Highland Head of Service vacancy, when the chair agreed to write to the Chief Executive and Chairman of NHS Highland to highlight the vacancy. The chair also added that there was a discussion about the escalation process if patient safety concerns are identified within the service, which could emerge from the sampling audits carried out by the Quality assurance subgroup.

Reference group and subgroups updates

The chair asked the chairs of each subgroup to provide updates for their respective group.

Reference group

AB advised the group that four surveys had been designed for the public engagement exercise – parents and carers of children and young people, young people (ages 13-18 years old), adults and professional who use with Audiologists. At the time of the meeting, it was expected the surveys would go live on the ALLIANCE website by the end of week commencing 12th December 2022. A number of social media channels will be used to promote these, and the links will be shared with review group and subgroup’s members for them to disseminate amongst their networks. Focus groups are planned in February to explore any issues further or to discuss any specific issues raised by subgroups.

AB also advised the reference group will want to be kept abreast of findings from the responses to the surveys as they come in. To this effect the reference group agreed to meet on a 3-weekly basis until the surveys close. The purpose of these meetings will be to interrogate data provided by the ALLIANCE which will include the quantity of responses, looking at ways to improve geographical spread if needed and to look at themes to share with the subgroups and review group.

Structure, leadership and governance subgroup

AC advised that his group’s questionnaire has been sent to Health Boards, and the closing date for submissions is 30th of December. This piece of work is currently marked as amber due to the delay in issuing. He added that Heads of Service have been alerted to the questionnaire being issued ahead of the live date. AC will provide a high-level summary for end of January/ early February. He advised that some Heads of Service have requested an extension for returns which has been granted, to 10 January 2023. DC added to the last point that the questionnaire may need to be escalated via the departmental and corporate management structure. He added it was good to know that senior management were supporting the process.

Quality assurance subgroup

JD advised the group that data from the KPI’s questionnaire, ABR and Hearing Aid audit sampling is being analysed. The data will provide a good foundation for the provision of recommendations. The subgroup plans to secure KPI's relating to quality and patient samples before their next meeting. JD thanked colleagues for their time for and work on the analysis. KPI’s responses were received from all health boards apart from NHS Highland which John has been chasing for a response. With regards to the case sampling audits, he has been chasing late responses ahead of a planned moderation meeting. He reinforced the importance of having a clear and robust mechanism for escalation if safety concerns are identified. He noted it was likely that the case sampling audit would identify some concerns, requiring formal escalation.

JD added that there is some potential crossover the structure, governance and leadership subgroup questionnaire. We are also mindful of the impact that several different requests for information may have on Boards and services. JD stated that the functionality of Objective Connect is causing some issues for group members to access and work on the surveys data analysis. He added that he had raised it with the review secretariat which is has been exploring using alternative collaborative working tools.

Education and training subgroup

RF advised that his subgroup has identified draft recommendations including CPD, registration, preregistration and formal training for trainers. The subgroup plans to hold two further meetings, the next one to review the draft recommendations and the final one review the section for the final report.

At its last meeting, the subgroup discussed that posts requiring specialist skills should only be open to those with formal qualifications whilst adhering to BAA recommendations.

At its most recent meeting, the subgroup discussed advanced practice, in particular the issue that not all staff in advanced roles have appropriate accreditation. This discussion was informed by a presentation about the higher training scheme. RF advised that NHS NES is providing financial support for applications to the BAA Higher Training Scheme until the end of March 2023, to allow audiologists to have recognition in specialist advanced practice. There have been 10 expressions of interest to date. RF has asked AC to reinforce this offering to the Heads of Service. CB advised that it is important to make trainers aware of the programme. It is also important for those supervising to have the experience and can offer appropriate guidance in exam preparation. JD suggested a UK-wide buddying network as a means of providing initial support. The chair added this would help create peer support, and that what was required is a “Train the trainer” programme. AC added there could a recommendation that appropriate job descriptions include an expectation to be studying towards the higher training scheme, the chair thanked all the chairs for their respective updates.

She discussed with the group job descriptions for Heads of Service and what criteria should be included. She added that the question of an appointments process for Heads of Service was discussed at a recent chairs meeting and that she subsequently wrote to the Chief Healthcare Science Officer to enquire if Scottish Government provide guidance on this process. The response stated that that there is no specific guidance, but that Boards used Partnership Information Network guidelines which are generic. She added that the Review may need to consider what the appointment process should include when drafting recommendations, particularly with regard to leadership skills, to ensure that staff appointed to leadership positions have the right skill set. CB mentioned the Academy of Healthcare Science has guidance on equivalence to the Higher Specialist Training with standards on proficiency for clinical scientists which could be used for audiology. She also stated the model is a good example of succession planning and required levels of competency for the Heads of Service roles.
AC added this is a change process which we need to work through. The chair added this is about managing transition and change in a careful way which is perceived by audiologists to be a positive way to improve patient safety. RF added the main point is peer review and externality, both of which were lacking in NHS Lothian.

AB advised of the need to be aware of other government priorities to ensure that the Review report is impactful and stands out. She referred to prior recommendations made previously which were not implemented because of other priorities. She emphasised the role of the group in ensuring the report and recommendations carry weight. The chair agreed, she mentioned a national structure which was disbanded and not replaced with an adequate alternative. It is likely that one of the recommendations will refer to the need for a national structure to have oversight and ownership of the recommendations.

The review vice-chair mentioned a framework for the recommendations and asked if there was a template to use. The chair described a provisional draft structure. She added it may be helpful to consider recommendations in a number of ways: they should be given prioritised and given timescales. It may be useful also to highlight recommendations which will be high impact but have lower financial implications such as the ones on reorganising structure. In addition, recommendations should have an indication of which body is responsible for implementation. CR added the importance of future proofing the recommendations. The chair added what is important are local and national structures which ensures quality assurance, external peer review, education, training and CPD for staff.

Forward look, any other business and date of next meeting

The chair discussed with the group her views on the layout of the report, advising there will be an introductory section which gives a background on the reason for the review, separate sections for each of the subgroups and reference group, a section for the BAA engagement work, and recommendations as described above. She stated a template can be drafted and discussions can be held on an agreed draft.

The chair asked if anyone had any other business to discuss, RF enquired about the process once the final review report is available. It was confirmed it is presented as a final report with the recommendations to the Cabinet Secretary before going for publication.

The chair advised the group that the visual timeline was shared with the group via Objective Connect and needed further updated to show that the final report would be ready by the end of March. She further advised there is another chairs meeting in early January and will provide an update to group members at the next review group.

The chair advised the next review group meeting is on the 31st of January 2023 and a further meeting will be held at the end of February.

The chair thanked everyone for their attendance and contributions at today’s meeting.