The UK Government have set out plans to reform the NHS Across England. Our Director of Strategy, Crystal Rolfe, explains how implementing these proposals could drastically improve the nation’s hearing health and finally deliver an NHS that is accessible for people who are deaf or have hearing loss.
About the new plan
The Government have published their long-awaited 10 Year Health Plan for England – Fit for the Future – which sets out the changes that they want to make to the NHS.
The plan builds on the intent to make three big shifts within the NHS – which RNID welcomed when they were announced – from sickness to prevention, analogue to digital, and from hospital to community. We believe that these are the right shifts for the NHS to make, and that the 10 Year Plan has identified exciting opportunities to transform the NHS.
Our response
At RNID we want to work with policy makers and service providers to take advantage of the opportunities the plan will create. We’ve identified three key areas where we believe there are exciting opportunities to make real systemic change. They are:
- Reforming audiology services
- Prompting and supporting people to take action when they have hearing loss
- Making the NHS accessible for people who are deaf or have hearing loss.
One of the key themes underpinning developments across the NHS Plan is the expanded use of the NHS App. The Government have announced a series of features which have the potential to transform NHS care in these areas – a “My” series of features (such as “My care” and “My consult”) to choose specialists, self-refer, hold remote consultations and bring an individual’s health data into one place amongst other things.
For these services to deliver on their potential, it is crucial that users are fully involved in the design of the new parts of the app. The App needs to work for the one in five adults in the UK living with a hearing loss, whether by prompting those with undiagnosed hearing loss to take action, or helping patients in the audiology system navigate the pathway to the service that’s right for them. It should also provide patients with support and follow-up in adjusting to their hearing aid, and finally breaking down the barriers that prevent the NHS from meeting the access needs of people who are deaf or have hearing loss.
RNID wants to work with the Department for Health and Social Care (DHSC) and NHS England to get this right. We are ready to share our evidence and support with researching the needs of our community with the App.
Reforming audiology services
Audiology is currently the worst performing diagnostic service within the NHS. At the moment, people are waiting too long for hospital-based audiology services. Part of the reason for this is that NHS Audiology services have been largely unchanged for 20 years – since the introduction of digital hearing aids.
One of the crucial shifts set out in the Government’s 10 Year Plan for the NHS is on where NHS care will be provided. Some services will be removed from secondary care in hospitals and placed within community services, closer to where people live. The key policy announcement is the development of the “Neighbourhood Health Service”. These will be single hubs closer to people’s homes, where multiple services can be delivered.
We believe that routine audiology cases are one of the services that should be removed from hospitals and placed into community care. We’ll be arguing for audiology services to be a key component of these new community services.
Remote services
We also share the government’s vision for remote services, potentially delivered by the proposed MyConsult element of the NHS App. The Government is proposing supporting remote care and moving from ‘bricks to clicks’ as the basis of NHS Care. We are fast approaching the point where audiology doesn’t need to be delivered in-person; giving patients a more convenient service, reducing costs and freeing staff time.
As well as reforming where NHS services are provided, the 10 Year Plan also sets a blueprint for how they are delivered. To pick just one example, the 10 Year Plan gives an example of dermatology services in which a healthcare professional photographs a patient’s skin, with the images sent off to a photo-lab where it is assessed by AI for diagnosis. If this is possible for dermatology then it should be possible for audiology. If images from an otoscope are analysed by AI then it could save a massive amount of time in audiology and provide a more convenient service to the patient.
Prompting and supporting people to take action when they have hearing loss
We know that hearing loss is hugely underdiagnosed, with roughly two-thirds of people who could benefit from hearing aids not using them.
The 10 Year Plan isn’t the first time government has promised to promote prevention and stop treating the NHS as a service to treat illness. But, in this new plan, there are ideas proposed which could really support people to value their hearing and take action.
Screening and early diagnosis can be key tools in improving the nation’s health and the 10 Year Plan shows how they can be used across the NHS. RNID continues to believe that simple hearing checks (like the one we have developed) can be embedded across various digital platforms to create a social norm around checking you hearing – changing attitudes to checking your hearing as you would your eyes and teeth.
The government will take this a step further and use the data people provide to the App and their single patient record, potentially supplemented by data from wearable tech, to provide tailored interventions and suggestions. We believe this is a huge opportunity to promote hearing checks in a targeted and effective way. A hearing check should be embedded within the App and people should be prompted to use it, particularly those with high-risk factors.
It’s also important the new financial model creates incentives to treat hearing loss more seriously, and we are cautiously optimistic about the proposals on this in the 10-Year Plan.
The risks of untreated hearing loss
The Government is proposing to move from an input or cost-based tariff to a system that rewards providers for the difference they make to the patients’ quality of life and preventing future NHS Care. Audiology should thrive under this system.
Clinical evidence shows that hearing aids are cost effective and have a beneficial effect in improving general health‐related quality of life. Untreated hearing loss can result in social isolation, which has been shown to increase the likelihood of developing dementia. Managing hearing loss with hearing aids can improve communication and support social engagement, both of which are important for maintaining overall well-being and brain health.
The new funding tariff could create important incentives for commissioners to be proactive in getting local populations to engage with audiology services. The way NHS funding works might, finally, be about to reflect the economic costs of hearing loss.
Making the NHS accessible for people who are deaf or have a hearing loss
For too long, millions of people who are deaf or have hearing loss have been failed by an NHS that doesn’t always meet their communication needs. Some GP surgeries may only allow patients to book an appointment by telephone, which isn’t accessible for people who are deaf or have hearing loss. Appointments may be missed when people don’t hear their name being called in the waiting room. Many who ask for a British Sign Language (BSL) interpreter don’t receive one. This is despite the fact that the NHS has a legal duty under the Equality Act to provide the “reasonable adjustments” that people need in order to have equal access to healthcare
Our recent report with SignHealth, Still Ignored – the fight for accessible healthcare, sets out the devastating consequences of this failure, including missed and delayed diagnosis, or people not understanding the outcome of their appointments or how to take their medication. Our report shows the NHS is still routinely failing to adhere to the Accessible Information Standard, a document that sets out how the NHS should meet the communication needs of patients with disability or sensory loss.
Improving lives for our communities
This situation must change – and the new NHS 10 year plan proposals offer exciting opportunities to improve the situation for people who are deaf or have hearing loss.
In particular, as mentioned, the 10 Year Plan sets out a goal for the NHS App to become a “front door” to the entire NHS – where patients go to manage medicines, book appointments, and communicate with their health team. They are key opportunities here to make the NHS more accessible to people who are deaf or have hearing loss, which must not be missed.
The document sets out a new plan for single patient record to be held on the NHS App – this will summarise a patient’s health information, and be accessible to GPs, as well as hospitals and other services. In addition, there are plans for a “My Companion” feature of the NHS App, which is designed to help patients articulate their health need and preferences. Recording patients’ communication needs and sharing them across the system are key requirements of the NHS Accessible Information Standard – but our research shows this is often not happening. These new plans represent a key opportunity to design the App such that people are able record their own communication needs, and to ensure that this information is able to be shared across the system as part of the Single Patient Record.
My Care and My Consult
Secondly, the new “My Care” tool on the NHS App is intended to be a one stop shop to let people manage their care, find and review their care plan, and book appointments – providing an alternative to the telephone for people who are deaf or have hearing loss.
A planned “My Consult” function on the NHS App is intended to allow patients to connect with clinician for remote consultations. This may represent an exciting opportunity to integrate video relay services (VRS) within the NHS system. VRS allows people who are deaf to make a video call to an interpreter.
While it isn’t suitable for everyone, it can be a valuable alternative when an interpreter is not available. Our Still Ignored survey showed that, at the moment, of those who need a communication support professional to be present during an appointment, only 7% say this is always provided for them. In addition, the NHS App should allow for people to book in person communication support ahead of their appointments.
Finally, in designing all the new functions of the NHS App, it will be vital to ensure that no group is excluded. RNID would be happy to work with DHSC ensure that inclusion is built into the app – that deaf people, those with hearing loss, and those with lower digital literacy all have their needs met.