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BSHAA consultation response: NICE hearing loss draft guidance

BSHAA is providing advice and guidance during the coronavirus pandemic, both for practitioners and the public. You can access the latest guidance by clicking the links below.

Here, BSHAA Council member PETER SYDSERFF summarises the key areas of the Society’s response…

In recent years BSHAA has pro-actively engaged with all parts of the sector to ensure that the views of members were considered and more importantly to influence policy and guidance documents to put improving patient outcomes at the heart of the evidence. The Society continues to challenge where no evidence is given.

The Society has challenged several key areas of the document and it will not surprise you to learn that the opinion of the Society is that the committee took a narrow view on who the guidance was to be produced for. The prevalence of audiology delivered in the community is largely overlooked and the document in places mixes clinical guidance with guidance written around funding with references to ‘complex audiology pathways’. This term is challenged wherever the Society sees it outside of conversations about funding because there is no evidence to support it.

Here are the three big points (there are others) that BSHAA fed back on:

Referral criteria

This is important for a couple of reasons and firstly BSHAA’s referral criteria have largely been ignored even though both BSHAA and BAA referral criteria have been referenced in the final scope. Secondly the committee appear to be happy to recommend the use of BAA guidance which reflects ‘broad clinical consensus’ but not clinical evidence. It is exactly this sort of wording that creates the opportunity for patients to needlessly be channelled through to more expensive and lengthier care pathways. The waiting times here alone are a poor patient experience and unjustifiable for the basic assessment.

Wax management

The Society supports the guideline committee in recommending that adults with earwax can and should be managed in primary and community settings wherever possible. What is not clear is why the committee has missed the opportunity to make the same recommendation about the provision of adult hearing services. The document is quick to reference other grey papers but here overlooked the advice of the National Commissioning Framework and Monitor (now NHS Improvement).

The role of the GP and community audiology

BSHAA is surprised and disappointed that given the evidence reviewed the GP appointment as part of an audiology referral was not overhauled. This is even more in focus given the known pressures on primary care at GP level and the advent of direct access for audiology. There remains no evidence or risk to support that the GP adds any benefit to the patient care pathway. If they did, then surely their intervention would also be relevant where a patient chooses to pay for a hearing aid?

There were many other points where BSHAA sought to support the committee in the production of this document and we sincerely hope that has been listened to.

BSHAA recognises that this is a really useful piece of work and thanks the committee for its contribution. However, your society will not stand by and allow credible guidance to be produced that can in anyway impact negatively on patients and the way in which members practice, wherever they choose to work.

BSHAA’s position remains to support members who are registered, autonomous professionals and who will make the right clinical decisions on when and where patients should be referred when appropriate. 90% of patients will not need this and this guidance should be exploring innovation to make care more accessible rather than harking back to provider centred models of delivery.