Quality Standards for Adult Hearing Rehabilitation Services

1. Quality Standards for Adult Hearing Rehabilitation Services

1.1 Context

In January 2003, the Public Health Institute of Scotland published a Needs Assessment Report on NHS Audiology Services in Scotland. This report identified a number of areas in which Audiology services were failing to meet the standards expected by service users and other stakeholders. These included:

• Inadequate facilities at base hospital, peripheral clinic and community sites.
• Shortages in qualified staff and staff skills leading to compromised service access and quality.
• Financial pressures compromising service quality, with an undue emphasis on activity at the expense of outcome.
• Poor or non-functioning inter-agency links.
• Large variations in services across NHS Boards.
• Inferior service quality and outcome in comparison to elsewhere in the UK and overseas.
• Recommendations and guidance from the NHS (particularly the Good Practice Guidance on Adult Hearing Aid Fittings), professional groups and voluntary organisations regarding service standards have not been implemented, despite the demonstration of their efficacy and effectiveness in other contexts.
• Good working practices are often not in place. Developments in Audiology services elsewhere in the UK are largely absent in Scotland.

As a result of these findings a number of recommendations were made by the Audiology Needs Assessment Group. Among these was the recommendation that " NHS Quality Improvement Scotland ( QIS) should produce an agreed set of standards for audiology services, and conduct an assessment of the service's ability to meet these standards, taking into account established documents from voluntary bodies and professional organisations".

In its response to this recommendation, NHSQIS indicated that it would not be possible to undertake the work within a timescale that was acceptable to the Group. It was then suggested that the work be undertaken by a sub-group of the Scottish Government's Audiology Services Advisory Group following the NHSQIS standards development methodology and that NHSQIS would subsequently quality assure the development process.

This document has been developed by a multi-disciplinary project group comprising representatives from the Audiology profession, the voluntary sector, higher education, UK health departments, senior NHS management and the private sector. In developing these standards the project group has adhered to the basic principles and guidelines laid out by NHS Quality Improvement Scotland. As a result it is expected that both the process of developing these standards and these standards will be quality assured by NHSQIS.

1.2 Background on the Development of the Standards

The development of these standards has been carried out by a multi-disciplinary group under the guidance of a sub-group of the Scottish Audiology Services Advisory Group ( ASAG) and following the principles and processes of NHS Quality Improvement Scotland.

The Audiology Services Advisory Group's remit is "to monitor the development of NHS audiology services in Scotland and to provide appropriate advice to NHS Boards, the Health Department and other relevant bodies that will facilitate effective and efficient development."

For more information on QIS please see the following website www.nhshealthquality.org

1.2.1 Basic Principles

Standards developed using the NHSQIS quality assurance process are required to be clear and measurable, based on appropriate evidence, and written to take into account other recognised standards and clinical guidelines. The standards are:

• written in simple language and available in a variety of formats.
• focused on clinical issues and include non-clinical factors that impact on the quality of care.
• developed by healthcare professionals and members of the public, and consulted on widely.
• regularly reviewed and revised to make sure they remain relevant and up to date.
• achievable but stretching.

1.2.2 Process

The way in which standards are developed is a key element of the quality assurance process. Project groups working on standards development are expected to:

• adopt an open and inclusive process involving members of the public, voluntary organisations and healthcare professionals.
• work within NHSQIS policies and procedures.
• test the measurability of draft standards by undertaking pilot reviews.

1.2.3 Format of Standards and Definition of Terminology

All standards quality assured using the NHSQIS process follow a similar format:

• Each standard has a title, which summarises the area on which that standard focuses.
• This is followed by the standard statement, which explains what level of performance needs to be achieved.
• The rationale section provides the reasons why the standard is considered to be important.
• The standard statement is expanded in the section headed criteria, which states exactly what must be achieved for the standard to be reached and how the service will achieve this, in that it is expected that they will be met wherever a service is provided. The criteria are numbered for the sole reason of making the document easier to work with, particularly for the assessment process. The number of the criteria is not a reflection of priority.

1.2.4 Assessment of Performance Against the Standards

Work to develop and define the assessment of performance against the Standards is in progress, based on the attached Quality Rating Tool. The Audiology Services Advisory Group is taking a lead in this work.