National Audiology Review Group minutes: February 2023

Attendees and apologies

• Jackie Taylor (JT), Chair of Review
• John Day (JD), Vice Chair of Review, Betsi Cadwaladr University Health Board, North Wales
• Adrian Carragher (AC), Scottish Heads of Audiology Group (HoA)
• Robert Farley (RF), NHS Education for Scotland (NES)
• Susan Campbell (SC), Universal Newborn Hearing Screening Programme
• Kathryn Lewis (KL), British Academy of Audiology (BAA)
• Jane Wild (JW), British Society of Audiology (BSA)
• Crystal Rolfe (CR), Royal National Institute for Deaf People (RNID)
• Lyn Hutchison (LH), National Services Division (NSD), National Services Scotland (NSS)
• Jim Harrigan (JH), Scottish Heads of Audiology Group (HoA)
• Catriona Johnson (CJ), National Services Division (NSS NSD), National Services Scotland
• Sandra McDougall (SM), Healthcare Improvement Scotland (HIS)

Apologies

• Samantha Lear (SL), National Deaf Children’s Society (NDCS)
• Angela Bonomy (AB), Sense Scotland
• Donna Corrigan (DC), British Society of Audiology (BSA)
• Andrew Murray (AM), Representative for NHS Boards Chief Executives
• Dr Shankar Rangan (SR), British Association of Paediatrician in Audiology (BAPA)
• Dr Shailaja Kottapalli (Deputy) (SK), British Association of Paediatrician in Audiology (BAPA)

Supported by

• Carole Campariol-Scott (CCS), Review Secretariat, Scottish Government
• Laura Sweeney (LS), Review Secretariat, Scottish Government 

Official observers

• Tony Rednall (TR), Scottish Government
• Claudine Duff (CD), Scottish Government
• Caroline Ballantyne (CB), Scottish Government
• Esther Black (EB), Scottish Government

Items and actions

Welcome and introductions

The chair welcomed all members and advised the group of apologies received. She added that today’s meeting would focus on the draft recommendations and further updates from each group.

Note of previous meeting, published minutes

The chair advised the group that the previous meeting note had been published on the review website. Meeting seven note was cleared by the review group members.

Action: review secretariat to clear meeting seven note with CNOD Senior Management and publish the note on the review website.

Chair’s update

The chair mentioned that some of the education recommendations may overlap with aspects of the ongoing Healthcare Science Review. She added that the Audiology course at Glasgow Caledonian University (GCU) had restarted. RF and the chair had a planned meeting this month with Catherine Ross to discuss restarting the BSc at QMU.

The chair said that the British Audiology Association (BAA) survey report has been completed and KL will give a high-level update on that later in the meeting. The chair hoped they might have some of the draft report to discuss today, but instead will focus on some draft recommendations, and will use the final review meeting on 21st of March to sign off the sections of the report.

It was also noted that subgroup members have ongoing problems accessing the Teams channel. The review secretariat added this was being investigated. The chair said group members should in the meantime email tracked changes versions of documents and use Objective Connect.

Action: review secretariat to update on access to Teams channel once advice from IT had been received.

The chair and vice chair wrote to Rachael Dunk, Deputy Director of the Chief Nursing Officer’s Directorate with three early recommendations from the Auditory Brainstem Response (ABR) survey. The Cabinet Secretary has been informed of the ABR case sampling.

The chair said the British Academy of Audiology (BAA) were checking on the Higher Training Scheme on ABR’s. KL confirmed that they want people to complete the module, rather than pursue the equivalence route. At present, a paediatric assessment module is not included, and this will be reviewed in June 2023. The recommendation is for people to complete the full module, to enhance potential for passing the assessment.

JD expressed his concerns on this and acknowledged it was due to the low success rate at examination. He added he had concerns about the cadre of people who perform the assessment of infants and raised the point about providing audiologists with the skills they need in a timely manner. The chair agreed that this is a concern. AC said there is a feeling of considerable pressure to move this forward quickly. He added that Heads of Service (HoS) have reached out on training issues to encourage people to bring training to Scotland, but that this requires a financial investment.

The chair thanked AC and said that funding issues are a recurring theme. She suggested that this be made clear in the recommendations.

RF agreed with JD and AC. He asked if there was an opportunity to involve the NHS Academy, if Higher Education was unable to provide the necessary training. The chair declared she had a potential conflict of interest as she had a role in the Academy. She suggested this particular training might be a route for CNOD to consider. The chair raised the question about assisting implementation of early recommendations.  JD suggested that remote supervision from another country could be another possibility. CR agreed. 

The chair indicated the findings from the ABR case sampling which prompted an urgent need to provide refresher training in ABR and establish an external peer review process. The chair introduced TR from CNOD at the Scottish Government to provide an update on the next steps about the early recommendations. 

TR explained that discussions took place with NSS NSD, HIS and their sponsor teams internally, and the Newborn Hearing Screening Team. The Cabinet Secretary has been made aware through a briefing paper that set out the concerns identified and the actions that would be taken as a matter of urgency for every case of significant concern to the relevant Audiologist, Head of Service, and Medical Director. The DG also wrote to Boards asking for implementation plan updates following the in NHS Lothian report from 2021. 

The chair thanked TR for his update and invited AC to speak and give his perspective on the ABR case sampling and provide feedback on the communications of the information to Health Boards. He raised the issue about staff feeling worried that their practice was being questioned; the need to put the cases with ongoing care into perspective as well as looking at the whole patient journey. He suggested a telephone call ahead of submitting the findings would have helped managing and preparing staff in dealing with the findings.

The chair thanked AC and agreed with the feedback on communications to the audiologists going forward, and that an updated letter with a more measured approach than the original wording should help dispel concerns.

CR agreed this should not be seen as a criticism of staff and it was important to acknowledge personal reactions. She added it was important to use this information to help staff reflect on service improvement, while understanding it would be difficult to take on board.

JH added he wanted to reiterate what AC said. JH also received a letter about the cases. He added that he had discussions with staff. He highlighted an issue of equipment being old at the time the ABR sampling was done, but that it had since been updated. AC added he had spent time with staff, reinforcing that the ABR audit is not personal criticism and hoped it would help staff take things on board. AC added he wanted to see the recommendation for external peer review enacted as soon as possible.

JD felt JH made a good point, that it would have been beneficial if auditors had come back and checked for more context and will look to do it differently in future. JD added this was a scaled down version of a peer review, as in a regular peer review context, there would normally be an opportunity to discuss the case with the individual being reviewed.

LH said it was a limited audit and findings needed to be investigated. She added the ethos of the review was to ensure that families were getting the best possible service which would mean correctly identifying hearing loss but that it had to be done in a supportive environment. She added that the findings might have been a one-off and that there was a need to secure additional resources to find out the extent of the problem, as well as training to get people to the standards required and to make sure the practices are the best that they can be.

CJ agreed and the chair said this ties in with the higher skills discussion. JD asked the group whether the training or the peer review came first. He added that there needed to be project to get peer review started and that this was linked to training. He added that every ABR is peer reviewed in Wales, which means every child is checked twice. The Wales system could be used in Scotland.

CJ asked if there was a model on impact on capacity for this and how support could be provided in participating in such a scheme given resourcing is tight. JD said that part of the contract in Public Health Wales and the Health Board includes Peer Review and that it didn’t meet the performance standards, this would lead to further discussions. He added it had a minor effect on resource.

The chair asked that The review group  be careful not to advise on implementation and to focus on the review aspect. AC added that the improvements that The review group  said needed to happen will be building on existing good practice; and this was about raising the bar and developing Audiology into one of the best services in the UK.

The chair added that this was about embedding a continuous quality improvement approach. The chair thanked AC and group members and introduced the next item, an update on the BAA audiology survey findings.

KL from the BAA shared a presentation on the main findings from the BAA survey for audiologists. The survey themes were:

• training and development
• governance and leadership
• raising concerns
• quality of service
• strengths, improvements and demonstrating value to stakeholder.

KL made the following points to the group:

• the training and development questions highlighted that there had been limited investment in Scotland for a long time. Responses said that while initially good, there were not many training opportunities longer-term, and the answers focussed on funding and budgets.
• there needed to be effective succession planning and there was lack of national representation. These were highlighted as necessary going forward.
• responses to the quality questions were mixed, and highlighted that quality depended on which Health Boards the service was provided in.
• staffing, training, facilities were highlighted consistently throughout the responses. These comments were applicable beyond Scotland and the respondents wanted the same high clinical standards applied across Scotland.
• there was lack of investment in people and leadership. The lack of support from management came through in feedback quite strongly. There is a short-term need for help with backfill and training. There are issues across the UK on where training comes after graduation.

The chair  suggested the quote at the end of the presentation should go in the final report from the Review. The chair asked if this was going to be published on the BAA website; KL said it would be for The review group  to decide. The chair said it would be helpful for each subgroup to cross-reference.

CJ said there were parallels with radiology services in Scotland, she mentioned the Scottish Radiology Transformation Programme which had made a significant impact on the service. CJ added that, while she agreed The review group shouldn’t be influencing how the review is implemented, there should be a recommendation for a body/ programme/ strategic network that will help deliver. She mentioned the Hearing Impairment Network in Paediatric Audiology but also added there wasn’t an equivalent for adults and that this needed to be pulled together with a structure and strategy.

The chair added that there was a need for a national advisory structure and that group’s first role would be to implement the recommendations of this report and that local Board accountability structure would be of equal importance. The chair asked The review group  they think the BAA report should be published.

RF said the BAA survey needs to be referenceable before we publish The review group  report. RF asked The review group  to acknowledge the findings of survey and how they are consistent with the discussions held by The review group . The review group  agreed about publishing the BAA survey. The chair asked if KL and SL can arrange for the report to be published on the BAA website. The chair thanked KL for sharing.

Action: KL and SL to arrange to have the BAA survey published on the BAA website.

Updates from subgroups

The chair asked each subgroup chair to share updates.

Education and training subgroup

RF said there is another Education and training subgroup meeting on the 7th of March when the group will frame a short piece for the report including the recommendations.

He added that the recommendation on a National Training Officer Role was changing into a more senior role. He also said that it wasn’t currently defined by a job description, but it could be in the form of a steering group and a project officer. He added it would require resource.

RF mentioned that the recommendations from the Universal Newborn Hearing Screening programme report from 2021 were supported by the Review. RF said funding for equivalency is available until the end of March from NES.

JD added that the final recommendation should be on how to implement the recommendations. JD then asked RF if the Clinical Scientist Training Programme (STP) was included in the recommendations as he was aware there hadn’t been Audiology STP’s. He highlighted that it works well in England and Wales as a way to get people into the workforce including with higher level training. RF said STP’s are a way of getting graduates into the NHS to train as an Audiologist, but that it hadn’t been looked at as a recommendation. JD added it was good that equivalency training was available too. JD said he would like RF to encourage STP in recommendations, as he felt it will help with future planning.

Structure, governance, and leadership subgroup

AC acknowledged the delay in the work of this group but that he was sending a first draft to his subgroup by the end of the week for feedback. The chair asked if workforce had been covered in the questionnaire sent to the Heads of Service at the time. AC confirmed it was covered in a couple of the questions and there would be narrative and some charts with information on the subject. He added he would like to include workforce data on service numbers.

Quality assurance subgroup

JD said the work of the Quality assurance subgroup had been on the ABR’s case sampling and working with the Scottish Government on communications to those Health Boards with such cases. JD is concerned that quality is compromised due to all the other pressures and wants to see support in the pursuit of quality. JD would like the Health Board to provide consistent submissions, but not just on waiting times data. When Health Boards were asked about quality, the responses tended to be around access time.

JD said there is an amount of overlap between the subgroups. He raised the point of where would quality feature within structures and governance, and which body will consider the outcomes at a national level. He posed the same question with regards to where quality and assurance are embedded within the Education and  training subgroup recommendations. JD said the recommendations will be finalised in the next two weeks.

The chair said she will ask the review chairs to meet to cover the areas of intersection and make sure there isn’t duplication of recommendations. She added that there is a need for appropriate structures nationally, leadership, visibility at the health board level – someone with executive accountability and authority, rather than competing with multiple other specialties.

Reference group

The review chair confirmed that while AB is not able to attend today, she would provide an update on her behalf as she attended the last reference group meeting on the 21st of February. She updated  the review group  on the ALLIANCE report about the recent engagement exercises, which included four surveys and some focus groups. The report is being finalised and will be shared once ready. The feedback was that it had been helpful and reinforced what we know the issues to be for service users. The chair made the following points about the main findings from the report:

• there was considerable variation in experience of audiology services.
• communication was very variable at every level, this included: methods of communication with people with hearing impairments, the need to support communication at appointments, such as communicating difficult news and supporting the family.
• the importance of multiagency working, vitally time sensitive with infants and children, still very important for adults. Individualised management plans aren’t always provided to patients, and referrals to other agencies does not always happen, Parents felt in some areas that they had a good experience, but this was very variable, – sometimes they had to drive the linkages with other agencies.

AB and the reference group are reviewing these findings and will come forward with any specific recommendations at the next meeting on 14th March 2023.

JD asked about patient reporting experience measures and whether this could be national or UK wide and be put to the reference group. He added he would like to see some standardisation in the way that the patient views and experience are gathered. The chair agreed that patient experience links in, and that service user input is needed when quality standards are devised. CR asked to make sure the reference group findings are sent to the subgroup in time, so that everyone hears the patient voice and so this is reflected in the final report.

Any other business

The chair reminded the group that the next meeting is on the 21st of March 2023, and that recommendations will be sent to the review group members ahead of the next meeting.

Action: review secretariat to chase the ALLIANCE for report to allow everyone time to read this prior to next meeting.