The Government has published an independent review of children’s audiology services, The Kingdon Review, commissioned following the identification of a series of failures in care for deaf children.
The findings of the Kingdon Review are deeply concerning. The harm caused to children and their families due to an overlooked and undervalued service is heartbreaking and completely unacceptable.
RNID welcomes the clear recognition of the longstanding issues within audiology services – issues that have been overlooked for far too long and must now be addressed.
In this blog, our Director of Strategy, Crystal Rolfe, looks at how this crisis emerged, the findings of the independent review and asks what should happen in adult audiology services as a result.
What are the findings of the Kingdon Review?
The key finding from the Kingdon Review is that children’s audiology services are treated as a ‘Cinderella’ service – “a service that is often overlooked, undervalued and underfunded”. The review states that the findings for children’s services are relevant for all audiology services, including those that support adults.
The treatment of audiology services as a ‘Cinderella’ service comes from the lack of national leadership: there is no national lead for audiology within the Department for Health and Social Care and there is no national oversight of meaningful data collection about the quality of services. This is a point that RNID made during the Kingdon Review and we are glad that it has been recognised.
The Kingdon Review also found that the audiology workforce, which straddles children’s and adult hearing services, has been neglected for years. The review highlighted a lack of oversight and regulation, poor quality training and the fact that Continuous Professional Development (CPD) is seen as a luxury that audiology services cannot justify.
The review also found serious problems with the way that incident response processes work, and the way in which persistent safety and quality issues within NHS services are raised with Ministers. This is a systemic problem which goes beyond audiology.
Twelve recommendations to improve services in England
The Kingdon Review makes twelve recommendations, these ensure that the NHS understands the scale of the problems which have been caused, place children’s hearing services on a secure footing for the future and apply the lessons from these failings to other similar services.
Some of the headline recommendations include:
- Requiring all audiologists to be registered on a single professional register – with linked improvements in training and CPD
- NHS trusts and Integrated Care Boards should implement improved governance arrangements for audiology services
- The next NHS Workforce Plan (currently being consulted upon) to include modelling and recommendations specific to audiology
- National research funding bodies should invest to unlock the potential of machine learning, data analysis and other technologies in children’s audiology – something which would also benefit adult services
We welcome the recommendations of the Kingdon Review. Full and speedy implementation of these recommendations will improve both children’s and adult hearing services for patients across England.
What does this mean for adult audiology services?
RNID agrees without reservation with the finding that all audiology services are treated as a ‘Cinderella’ service – including adult services. Up until 2022, we were fighting unjust commissioning decisions to restrict the provision of hearing of hearing aids for patients with a mild to moderate hearing loss, despite the strong clinical and cost-effective evidence on the benefit that hearing aids can make.
Although the Kingdon Review focuses on children’s hearing services it is important to remember that adult and paediatric services share a great deal of infrastructure, including workforce and governance, which were heavily criticised by the review.
We know that adult services are not performing well. Audiology has some of the longest waiting times for diagnostic services across England. Latest data shows that in August 2025 over 110,000 people were waiting for an audiology test and one in four of those on the waiting list have been waiting more than 13 weeks. These waiting lists exist despite the fact that one in three adults have some form of hearing loss, and the majority of those that could benefit from hearing aids are not even seeking help for their hearing loss.
There are huge inconsistencies in the way that adult services are delivered – something that wouldn’t happen with effective national oversight and governance. Whether it’s the provision of Bluetooth-enabled hearing aids, the failure to provide aftercare or the implementation of usable self-referral pathways – audiology services are not meeting best practice or acting in the best interests of patients.
RNID sees huge potential in the role of technology and innovation to improve service quality for patients and make hearing healthcare services fit for the future. The Kingdon review highlighted that despite the potential for research and innovation within audiology, little is carried out.
Furthermore, some services are also unable to carry out research due to outdated equipment, meaning they are already on the back foot when it comes to piloting and adopting technological advancements that could improve patient care. Investment in updated and improved facilities is essential to scaling existing technologies, as well as testing technology of the future.
What should happen next?
It’s finally time for hearing health services to be treated as an essential and core part of our NHS.
We welcome the focus on national leadership and the recruitment of a National Specialist Adviser for Hearing and Associated conditions. RNID will want to work closely with the postholder to improve the profile of audiology across the NHS.
There are a number of opportunities set out in the Government’s Ten Year Plan which cannot pass audiology by. These include the rollout of the new Neighbourhood Health Services and Community Diagnostic Centres, the use of the NHS App to push health checks and the investment in technology and AI to improve patient outcomes.
We also agree that there must be a greater focus and investment in the workforce. Investment in the workforce needs to be part of a modernisation of hearing services – training professionals on the latest technologies, and creating a forward looking service which is ready to embrace potential new ways of delivering hearing healthcare.
Finally, we want the way in which safety and quality concerns are reported and presented to Ministers to be improved as Kingdon recommends. This is crucial in audiology but applies to all NHS services. As the Kingdon Review notes, accessibility and deaf awareness is often lacking in NHS services, as we have evidenced in our Still Ignored report. Yet the cumulative impact and patient harm of inaccessible healthcare is rarely understood by commissioners, let alone national policy makers at the DHSC or NHS England. Better reporting mechanisms can help ensure that when individual harm occurs it can be a spur to systematic change.
Children and adults across England with hearing loss have been let down by the NHS. By treating audiology as a ‘Cinderella’ service the NHS has devalued the impact that hearing loss on an individual’s quality of life.
The Kingdon Review must be a wake-up call to the NHS. By setting in place the national leadership and oversight that audiology requires the DHSC can set in motion a transformation in the national hearing health.
Why did the Government commission the Kingdon Review?
In December 2021, the NHS Newborn Hearing Screening Programme (NHSP) for England identified five sites that were diagnosing notably fewer deaf children than expected compared to national averages. This raised significant concerns about the diagnosis and management of deaf children nationally, indicating serious problems with the quality of children’s hearing services.
An increasing number of missed diagnoses have since been identified across England, however, despite new cases being flagged, there has so far been no systematic change in how services are delivered.
NHS England has identified over 300 children who were failed by audiology services, although that number is likely to be an underestimate according to the Kingdon Review.
These failings will end up having a profound and lasting impact on these children’s lives. Failure to identify a deaf child during the ‘critical window’ of brain development will impede the crucial acquisition of language – and prevent parents making informed choices about their children’s future, such as whether to use hearing aids or cochlear implants, communicate with speech, learn British Sign Language or use a combination.
The Government commissioned an independent review of the crisis in May 2025 – led by Camilla Kingdon, a former President of the Royal College of Paediatrics and Child Health. The Kingdon Review was tasked with considering:
- NHS England’s response to the service failures in children’s hearing services
- how the relevant governance arrangements between NHS England and the Department of Health and Social Care (DHSC) could be improved, and identify lessons learned
- how NHS England’s handling of any future failures in similar services could be improved, and identify lessons learned
Prior to the Kingdon Review, similar concerns were identified in children’s hearing services across Scotland. This led the Scottish Government to commission The Independent Review of Audiology Services in Scotland, which was published in the summer of 2023. Read our response to that review.
- Read the letter from the Secretary of State for Health and Social Care to Dr Camilla Kingdon.