National Audiology Review Group: terms of reference

Background and strategic context

In January 2022 the Cabinet Secretary of Health and Social Care announced a National Audiology Review would be established to examine hearing services provided to both children and adults in Health Boards across Scotland, to ensure public confidence in the quality and effectiveness of current service provision. The group will provide recommendations for a national plan for improvement of the service and its specific purpose and scope has been detailed below.

The Independent Review of Audiology was announced following the publication of an Independent Review into the Paediatric Audiology Service in NHS Lothian, carried out by the British Academy of Audiology (BAA) in response to a complaint upheld by the Scottish Public Services Ombudsman.

It is estimated there are 945,000 people living with hearing loss in Scotland, one in six of the population, and of those, 70 per cent are over 70. This figure is projected to increase by 50 per cent by 2034. Of this, there are an estimated number of 3,600 young people. The national availability of Universal Newborn Hearing Screening at birth facilitates early intervention and support.

The Health and Social Care Alliance Scotland (now incl. Deafblind Scotland) estimate 5,000 people have significant hearing and sight loss, mostly over 60 and having become dual sensory impaired as part of the ageing process. 

In March 2022 the Cabinet Secretary for Health and Social Care appointed Professor Jacqueline Taylor to the role of an Independent Chair to provide leadership to the National Audiology Review Group.

Purpose and scope

The purpose of the Review Group is to establish the current level of assurance within existing audiology services, to review this within scope of the Review and to make recommendations to improve the assurance of audiology services within NHS Scotland. The remit of the Review Group will be to:

• review current structure, governance and leadership of Paediatric and Adult Audiology services
• provide a quality assurance appraisal of services, surveying key elements of existing service provision, with a particular focus on issues impacting on patient outcomes
• review existing quality assurance arrangements, making recommendations necessary to establish robust quality assurance processes, whilst progressing service quality, improvement and outcomes for patients on a permanent basis
• review current education and training and continued professional development provision
• to understand the lived experience of people living with sensory loss and their carers and families

The Review Group may consider previous and ongoing work in this area, including:

• the See Hear Strategy currently being taken forward by the Scottish Government
• progress with the Universal New-born Hearing Screening Programme
• work undertaken by the Scottish Heads of Audiology Group, Hearing Impairment Network for Children and Young People and existing diagnostic Strategic Groups in consideration of any identified opportunities for improving audiology services
• use of established and evidenced based Quality Standards for Adult Rehabilitative Audiology and Paediatric Audiology Services
• the Healthcare Science Education and Workforce Review underway by Scottish Government
• recommendations proposed by the National Deaf Children’s Society and any work undertaken by wider partners

For clarity, it is noted the following is out of scope for the work of this Review:

• non NHS provision
• waiting time improvement plan
• ear wax management services
• a detailed workforce plan

While it is not the role of the review to undertake a clinical audit by NHS Board area, the review will examine key performance indicators to determine the quality of current service provision with the aim of identifying any wider issues. This will include examining specific topic areas in order to make recommendations to improve the assurance of audiology services within NHS Scotland.

It is also to be noted that the review Group will not immediately consider issues around regulation of audiologists as this is subject of a recent UK-wide consultation. Any implications that might arise from the outcome could be considered by the review Group if appropriate or necessary.

Approach and review process

The specific methodology of the review is at the discretion of the Chair however it is expected this will reflect an immediate to medium term approach and seek to develop proposals and draw conclusions from evaluation of a wide array of sources.

Phase one – scoping and engagement

The review will include drawing on existing NHS Scotland data and collection of new data where required. Evidence may be gathered through a variety of methods, including (but not limited to): 

• drawing together and evaluating existing academic research and best practice, reports and databases
• commissioning surveys
• engagement with key interested parties including: professionals, any sector representative bodies and people with lived experience

Further engagement will be supported by the third sector and a separate Reference Group to ensure the involvement of people who have lived experience and their families.

Phase two – plan of action

Using the information and evidence derived from the first phase, the review will consider what change is needed and what the options are for delivering an improved system. This work will be organised in the following workstreams:

• • structure, governance and leadership
  • quality assurance
  • education and training

The review and its workstreams will consider personal experiences of users of paediatric and adult audiology services, to help shape the service in the future through the Reference Group.

The review will also seek to collect and consider information on the operation of other audiology services across the four nations that might provide models for consideration and comparison. The review will reflect on previous attempts at reform in Scotland and will ensure that lessons learned from these experiences are reflected within its thinking.

Deliverables

Arising recommendations will be provided to the Cabinet Secretary for Health and Social Care within the timescales the review group deems necessary.

We anticipate that the review group will report over a nine month period, starting in May 2022. This report will make such recommendations as the review group considers appropriate in relation to improving audiology services in terms of any of the matters listed under Remit, and any other recommendations as the Chair considers appropriate.

The Chair will also provide a written update on behalf of the review group to the Cabinet Secretary for Health and Social Care at an agreed mid-mark.

Communications and information-sharing

In line with independence but reflecting the Scottish Government’s contribution to the review as secretariat, the Scottish Government will establish secure record-keeping mechanisms that keep material relating to the review group separate from general information held by the Scottish Government. This will make clear that, for the purposes of FOISA, the Scottish Government is holding this information on behalf of the review.

The Scottish Government, including in its role as secretariat to the review group, is subject to requests for information under FOISA. This means that material provided to officials acting in a secretariat role by the review group would be information held by the Scottish Government for the purposes of FOISA. In the event of a request for information being received the Scottish Government would, in the usual way, consider if any exemptions applied to the release of the information. Consideration of exemptions may involve the application of the public interest test.

The Scottish Government in its secretariat role will ensure that any data is processed in compliance with the UK General Data Protection Regulations and the Data Protection Act 2018.

To support public understanding of the work of the review group, the Scottish Government in its secretariat role will publish terms of reference, high level work plan and minutes of meetings. The review group will consider the publication of other information where appropriate.

Otherwise, review group discussions are confidential. review materials and any information about the subjects discussed are confidential and not to be saved on IT systems and/or shared with third parties.

Timescales and meeting schedule

The National Audiology Review Group will meet on a six-week frequency virtually and the meeting schedule will be confirmed by the Chair. Frequency and timing of meetings will be kept under review.

The Chair has discretion to set the format of any meetings in a way that best suits the subject matter for discussion, having taken into account the views of working group members or ad hoc participants. As needed, the Scottish Government can provide physical meeting rooms for the purposes of in-person or hybrid meetings.

Any sub groups arising from the review group will meet sufficiently regularly to ensure that their remit is delivered effectively. Each sub group will have its own Terms of Reference.

Minutes for each meeting will be taken by a member of the review Secretariat Team at the Scottish Government, who is providing secretariat support. Minutes for meetings will be published within agreed timescales on the Scottish Government website. Meeting minutes must be agreed by the Chair after each meeting prior to publication.

Membership

Membership for the National Audiology Review Group will reflect key stakeholders across the clinical pathway across the healthcare system and areas of consideration for the work of the review as well as interested third sector organisations who have key stakeholder engagement experience with those with lived experience. It is noted that the Reference Group which will enable wider input from a lived experience perspective will have its own agreed Terms of Reference.

It is expected that members of the review group will share stakeholder communications with the organisations and/or groups they represent.

The review group is comprised of:

Attendee	Deputy
Professor Jacqueline Taylor, Chair of National Audiology Review Group	N/A
John Day, clinical Director of Audiology, NHS Wales	N/A
Angela Bonomy, Chief Executive Officer, Sense Scotland	N/A
Jim Harrigan, Head of Paediatric in NHS Greater Glasgow & Clyde	David Comiskey, Head of Service, NHS Fife
Adrian Carragher, Head of Audiology, NHS Ayrshire and Arran	Stephanie Doody, Head of Service, NHS Forth Valley
N/A	Richard Locke, Lead Clinician for ENT, NHS Greater Glasgow and Clyde
Catriona Johnson, Associate Director for Managed Clinical Networks, Hearing Impairment Network for Children and Young People	N/A
Susan Campbell, Clinical Lead, Newborn Hearing Screening Scotland	N/A
Dr Robert Farley, Associate Director (Healthcare Science), NHS Education for Scotland	Claire Cameron, Healthcare Science Principal Lead, NHS Education for Scotland Lorna Crawford, Healthcare Science Principal Lead, NHS Education for Scotland
Sandra McDougall, Deputy Director of Quality Assurance, Healthcare Improvement Scotland	Kevin Freeman-Ferguson, Head of Service Review, Healthcare Improvement Scotland
Lyn Hutchison, Senior Programme Manager for the Pregnancy and Newborn Screening Programmes, National Services Division, National Services Scotland	N/A
Dr Andrew Murray, Medical Director of Forth Valley, NHS Health Boards, Board Chief Executives	N/A
Kathryn Lewis, Head of Audiology (President of BAA), British Academy of Audiology	Claire Benton, Head of Audiology at Nottingham University NHS Trust, British Academy of Audiology
Donna Corrigan, Chair, British Society of Audiology	Jane Wild, Council Secretary, British Society of Audiology
Dr Sam Lear, Senior Audiology Advisor, National Deaf Children’s Society	Mark Ballard, Head of Policy and Influencing Scotland, National Deaf Children’s Society
Crystal Rolfe, Associate Director for Strategy – Health, Royal National Institute for Deaf People	Franki Oliver, Audiology Advisor, Royal National Institute for Deaf People
Dr Shankar Rangan, Executive Committee, The British Association of Paediatricians in Audiology (BAPA)	Dr Shailaja Kottapalli, Executive Committee, The British Association of Paediatricians in Audiology (BAPA)[

Representatives of Scottish Government policy teams for the Community Hearing Service and Healthcare Science Education may sit on this group as official observers.

Membership will be kept under review and the roles and responsibilities of the members will be set by the Chair.

Secretariat

The Scottish Government in its secretariat role to the Chair and review group will prepare meeting papers, and generally advise and provide support to enable groups to operate effectively.