National Audiology Review Group minutes: January 2023

Attendees and apologies

• Jackie Taylor (JT), Chair of Review
• John Day (JD), Vice Chair of Review and Betsi Cadwaladr University Health Board, North Wales
• Adrian Carragher (AC), Scottish Heads of Audiology Group (HoA)
• Robert Farley (RF), NHS Education for Scotland (NES)
• Angela Bonomy (AB), Sense Scotland
• 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)
• Jane Wild (JW), British Society of Audiology
• Crystal Rolfe (CR), Royal National Institute for Deaf People (RNID)
• Lyn Hutchison (LH), National Specialist and Screening Services Directorate (NSS NSD)
• Jim Harrigan (JH), Scottish Heads of Audiology Group (HoA)
• Catriona Johnson (CJ), National Services Scotland, National Services Division (NSS NSD)
• Sandra McDougall (SM), Healthcare Improvement Scotland (HIS)
• Anne Marsden (AM), British Association of Paediatrician in Audiology (BAPA)

Apologies

• 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, Review Secretariat, Scottish Government
•  Julie Townsend, Review Secretariat, Scottish Government 

Official observers

• Caroline Ballantyne, Scottish Government
• 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. The chair welcomed Dr Anne Marsden, who is joining the meeting today in place of Dr Rangan and Dr Kottapalli for BAPA.

Note of previous meeting, published minutes

The chair advised the group that all previous meeting notes are now on Objective Connect and published on the Review website. Meeting 6 note was cleared by the review group members.

Action: review secretariat to clear the meeting 6 note with CNOD senior management and publish the note on the Review website.

The chair mentioned an action from the meeting 5 note in relation to her letter to the Cabinet Secretary about two early recommendations on restarting courses at GCU and Queen Margaret University (QMU). The Cabinet Secretary responded and highlighted the Glasgow Caledonian University (GCU) courses will have an intake in 2023. However the recommendation on the QMU courses is pending due to the ongoing review of the Healthcare Science Education programme. A written update from the CNOD Education yeam has been drafted and is currently with Catherine Ross, Chief Healthcare Science Officer (CHCSO) for review when she returns from leave on 1 February. AC highlighted the concerns about the number of audiologists in practice and to be aware of this and of the opportunity to highlight this point around increasing workforce and budgets. The chair acknowledged this point but reiterated that a workforce plan was not in the remit of the Review.

RF confirmed that Sarah Smith, Professional Adviser for Healthcare Science Education and Workforce, has prepared a paper about Healthcare Science Education and Training Scoping Review, and this will be discussed at the next Education and training subgroup meeting on 13 February 2023. RF referred to a recent letter from the CHCSO providing an update to stakeholders involved in the Healthcare Science Education and Training Scoping Review. The chair asked to see a copy of it.

Action: review secretariat to receive advice for the chair from the CNOD Education team about the early recommendations once the CHCSO has responded. Review secretariat to forward letter from the CHCSO to the chair.

The chair also confirmed the forthcoming BAA meeting.

Action: chair to attend the BAA meeting on 6 February 2023. 

Update from the chair

The chair advised the group that the Interim Reporting meeting with the Cabinet Secretary took place on Monday 19 December 2022 and the discussion was very positive. The Cabinet Secretary confirmed his commitment to the Review. The chair also informed the group of further meetings with the group Chairs and the progress being made. The chair asked SL to provide a brief verbal update. The BAA survey has now closed and SL confirmed 60 responses to the survey had been received, which was considered to be a good response rate and a wide range of responses. Three workshops were held (one for Heads of Service and two for Audiologists). Data was currently being analysed and a report should be ready within the next two weeks.

Action: chair advised that recommendations from the survey should be shared as soon as possible to inform the final Review report and particularly for discussion at forthcoming sub group meetings as recommendations begin to be drafted. SL agreed.

The chair updated the group on the NHS Highland Head of Service vacancy. The chair wrote to the Chief Executive and Chairman of NHS Highland in December last year to highlight the vacancy. The chair confirmed that CHCSO was meeting with the chair at Highland shortly but that the post had been advertised in the interim. SL confirmed that NDCS met with NHS Highland recently and discussions including equipment and quality issues were highlighted along with concerns around the structure of the service. SL suggested that areas such as this, including leadership challenges could possibly be included in the Review report. This issue would be picked up following the completed Health Board questionnaire returns to AC for analysis by his subgroup on Structure, governance and leadership.

JD highlighted quality assurance and asked RF if his Education and training subgroup were considering national job descriptions which would include leadership criteria. RF confirmed it has had these discussions and would frame the recommendations.

The chair discussed the layout of the final Review report around a Foreword; Introduction; Executive Summary including all of the recommendations and separate sections for each of the subgroups, reference group; and the BAA engagement work. All members will be given access through a Teams channel invite. The draft sections will be circulated on Teams, seeking comments and returned to chairs of each subgroups for consideration.

Action: the chair confirmed that a draft report should be available by the next review group meeting on 28 February, with a further meeting in March (and possibly an additional one required for sign off).

The chair highlighted the Teams channels that has been made available for the review chairs and asked if they now had access and there were no issues reported. The chairs confirmed they had access to their individual subgroup Teams channels.

Action: review secretariat will ensure all members have Teams access by mid-February 2023.

CR discussed what would be put in place to ensure the Review work will move forward beyond publication, and what was the mechanism to take forward the recommendations. JT confirmed that in discussion with the Scottish Government there would be an implementation group to oversee this work ensuring improvements to deliver robust patient care. The Review is also likely to make recommendations on local and national structures which would continually monitor service quality and delivery.

Reference group and subgroup updates

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

Reference Group

AB gave an update on the ALLIANCE surveys. AB had a meeting scheduled with the ALLIANCE and will take this to the next reference group meeting on 2nd of February. The surveys closed today and 212 responses had been received to date. AB said it was a very positive response and that there was evidence of use of free text, as well as a good geographical spread over NHS Boards. She added that there wasn’t a good uptake for the adult focus group, but AB felt this was not surprising. NDCS are leading on a young people focus group on 13 February. Some of the themes coming through are practical barriers to using audiology services, i.e, access, equipment, staff and waiting times.

The Alliance will carry out thematic analysis to present to the next reference group meeting. Patient lived experience which highlights known issues will be used to reinforce recommendations in the relevant section. New issues highlighted by the surveys will be captured and reported and may require their own recommendations. AB confirmed that she meets regularly with all subgroup chairs and all the detail from the surveys will feed into the work of the other review subgroups. SL will also feed into the subgroups around the BAA Survey, with a separate section in the Review report, as confirmed earlier in the meeting.

Action: AB to share all the data analysis with the reference group for discussion and then feed into the Review subgroups next week. CR confirmed RNID can offer help with the adult focus group.

Structure, governance and leadership subgroup

AC advised that all responses to the questionnaire had been received. AC confirmed that there is a slight delay with the analysis of data and creating a narrative. He will ask for subgroup volunteers with help utilising their expertise to summarise the details ahead of the next subgroup meeting on 7 February.

Action: AC to agree volunteers and move forward with analysis of data for discussion on 7 February and sharing at the next review group meeting on 28 February 2023. SL offered to provide early data on structure emerging from the BAA survey.

Quality assurance subgroup

JD advised the subgroup is on track for providing recommendations and feeding into the final report for the end of March 2023. JD confirmed that analysis was progressing well and despite the limitations, mentioned previously to the Cabinet Secretary, a lot of data has been gathered through the KPI’s, surveys on quality assurance processes at NHS Boards and from the patient sampling audits. Also, discussions and briefing on other processes ie. Improving Quality in Physiological Services (IQIPS) and Scotland/Wales quality standards and audit have taken place.

Looking at case sampling audits and escalating cases of significant concerns, JD confirmed that a clear process has been defined with SG. JD presented on the process and results of the ABR patient sampling audit and made recommendations for escalation. On behalf of the QA group JD made three recommendations to the review group for approval as follows:

• deep dive audit of ABR assessment
• training in ABR
• introduction of ABR Peer Review

Action: feedback from the sample audits from the auditor will go back to the Audiologist through the review secretariat team and those cases for escalation will be highlighted by the QA chair to the review secretariat team to take forward as part of the formal SG process and the NHS Boards.

Action: the chair to write to the Cabinet Secretary to confirm these recommendations moving forward and review secretariat to update CHCSO and interested policy areas.

As an observation, AM added that there are challenges to improving services and that while collaboration is good, a robust network of appropriately qualified audiologists is required for the peer review process.

AB discussed the Hearing Impairment Network for Children and Young People Managed Clinical Network (HINCYP). She added that a lot of the work was paused until the outcome of the Review was known and highlighted there may already be a group within this network that could collaborate in this work.

It was agreed that there was a real appetite for training and the Peer Review is not new and the real value needs to be recognised. The importance of the entire patient pathway and risks around staff skills and knowledge was also highlighted.

Education and training subgroup

RF advised that his subgroup would next meet on 13 February and has identified draft recommendations around broad headings – CPD; foundation training; Registration/QA; advanced practice; verification of training; leadership and system quality.

Action: Education and Training subgroup to review the draft recommendations and consolidate the report section for the final report. By the end of February, the chapter would be ready to go to the review group for further comments.

The subgroup may reconvene early March taking account of findings of other Review surveys.

JD asked SL about BAA and Higher Training Scheme for the ABR Peer Review and SL will look into this and feedback to the review group. It could be seen as a very good steppingstone.

Action: SL to look at the BAA Higher Training Scheme for the ABR Peer Review and feedback to the review group.

Forward look, any other business and date of next meeting

The chair closed the meeting and actions were recorded. There was no AOB. The next review group meeting 8 will take place on 28 February 2023.