Audiology Update for Health Board Exec Directors of Therapies and Health Science

Venue: Welsh Government, Cardiff

January 2019

John Day

Clinical Director of Audiology and Consultant Clinical Scientist (Audiology), BCU Health Board, on behalf of Audiology Heads of Service Group

Framework Actions (33) :

Public Health Wales (3)Social Services and Healthboards (9)Healthboards (8)Social Services (4)Community Health Councils (1)Welsh Government (5)Third Sector (3)

Organisation

• Project Board– Chaired by WG Chief Nursing Officer

– WG Policy Officers

– Audiology reps (4)

– Social Services

– Third Sector

– ENT

– Primary Care,

– Rep Dir Therapies & Health Science

Framework Actions – Who is doing what:

Public Health Wales

Advice - Prevention

Raise Awareness of Identification

Raise Awareness of Support

Framework Actions – Who is doing what:

Social Services

Develop national standards

Ensure care and assessment meets needs of people with hearing loss

Training and Education of staff

Good practice guidance

Framework Actions – Who is doing what:

Welsh Government

Establish All Wales project board

Investigate registration of people with hearing loss

Review outcome measurement

Ensure consistency of message

Framework Actions – Who is doing what:

Third Sector & CHCs

Engage service users

Co-ordinate feedback

Collaborate within third sector

Raise Awareness

Signpost

Framework Actions – Who is doing what:

Social Services and Healthboards

Establish local collaborative groups

Referral between agencies

Care home provision

Flag system to ID people

Raising awareness of access

Self-management

PREMS and PROMS

Health Board Actions

• Local collaborative groups to inform national planning

• Primary and community delivery of audiology

• Workforce planning for Audiology capacity

• Pathway improvement inc wax removal

• Extend service quality standards to additional areas

• Post screening pathways for ID of Hearing Loss in children

• Pathways for on-going support for adult hearing aid users

• Dementia pathways and hearing loss

Health Boards contd... Actions Direct HoS Group Actions

(what HoS can do internally as a group)

Indirect HoS Group Actions (what HoS can contribute to locally and nationally ) in partnership with other stakeholders

Individual HoS actions (what individual HoS can do at local HB/service level)

Action 19: Scope, develop and implement a plan to deliver a nationally agreed pathway for, battery provision and ongoing hearing aid maintenance, including self management, battery management and volunteer peer support. Work with third sector to develop and deliver ongoing peer support schemes for people with hearing aids, in line with the Welsh Government guidance: ‘Volunteer Schemes to Support Adults who use hearing aids 2011’ and define the extended use of volunteers.

Share current models/pathways for battery provision and HA maintenance. Share current practice, potential innovative approaches and materials around: self management programmes volunteer support schemes. Review 2011 volunteer scheme guidance document and update based on experiences to date and extended use

Contribute to national multiagency task and finish groups concerned with this task (on-going support for adult hearing aid patients)

Locally,seek necessary enabling support for, and implement changes to on-going support for adult hearing aid patients

Action 20: Embed consideration of hearing status as part of in-patient pathways for people with dementia, and in out-patient memory care pathways for diagnosis of dementia. Develop dementia friendly hearing services, including a system of alert for people living with dementia, specialist assessment and rehabilitation, and on-going support and review.

Share current practice, progress, materials and evaluation related to identification, assessment and rehabilitation of people with hearing loss and with or suspected of having dementia Share current practice related to the development of dementia friendly services

Contribute to a national multidisciplinary working group reviewing assessment of hearing status for people with or suspected of having dementia. Contribute to an options appraisal considering the most clinically and cost effective model for identification of communication difficulties in people diagnosed with suspected of having dementia

Make links locally with dementia and mental health teams to ensure engagement with the development and implementation of any new pathways and service models Seek necessary enabling support for, and implement changes.

Progress to Date:

Nationally:

• Project Board has met on 5 occasions

• Task and Finish Groups established for

– School Entry Hearing Screening

– Cerumen management

• Plans shared by Audiology HOS Group and third sector

• Links with Dementia National Plan

The Wider Context

• Hearing loss is strongly associated with an increased rate of cognitive decline and an increased risk of dementia.

• There is evidence to suggest that people with mild hearing loss are almost twice as likely to develop dementia.

• The risk for people with moderate hearing loss is three times higher, and for people with severe hearing loss it is almost five times higher.

Dementia and Hearing Loss

Dementia and Hearing Aid Use

Dementia and National Framework

Ingredients for Success: Local Health Boards

1. Establish multiagency Hearing Loss Collaborative group at local level (health boards, LA, third sector, service user reps) to pursue framework actions.

2. Champion the framework within your health board3. Ensure IMTPs feature reference to the framework4. Challenge your operational management colleagues to

deliver against these actions5. Check your workforce plans for Audiology6. Pursue key deliverables as priority:

• Primary Care Audiology• Wax removal pathways• Dementia pathways, School Screening

Association of Directors

of Social Services

Implementation Group - All Wales

Standards for Communication of People with sensory

Loss

Alliance of Deaf Organisations in

Wales (Third Sector)

Audiology Professional

Advisory Group + Heads of Audiology

Services Group

ENT Planned Care Board

Newborn Hearing

Screening WalesNational

Project Board

Local Hearing Loss Collaborative Care Groups

Regional Partnership Boards

Local Authorities

Health Board

Local Third Sector

NationalCollaboration

Local Collaboration

Wax Removal• Wax results in hearing loss that is relatively easy to manage• Traditionally patients saw their GP for wax removal.• The GMS contract does not specify wax removal• Many patients are being turned away• Instruction from Cabinet Secretary to Health Boards –

responsibility lies with Health boards to ensure access to removal through the NHS.

• NICE guidance (2018) covers the location (primary care) and means of removal

• T&F Group Established nationally• Pathway is being defined• Establish local implementation group to implement

Primary Care Audiology: Moving Audiology Upstream

Patient

ENT

GP/Primary Care

Audiologist

‘1948’ Model – 3 appointments

Patient

Patient

GP/Primary Care

ENT

ENT

Audiologist

1990’s model – 2 appointments

Prudent model (Wales 2016/17) – 1 appointment

GP/Primary Care

Primary Care Audiologist Audiologist

1. Audiology Primary Care Practitioner – The Concept

Balance Pathway

AHLP

Tinnitus Pathway

Paediatric Audiology Pathway

Criteria based BPPV Screen and treatment

Sudden SNHL

Primary Triage to AHLP (inc LD/Dementia)

Outer Ear Management

Tinnitus - primary management

Primary care paediatrics

Primary Care Secondary Care

ROLE

Primary Care Audiology : Streams

+ Wax removal associated with above

•

Main departments& Regular Clinics in the community

Care Closer to Home North Wales: Adult Audiology locations

•

3 Main departments16+2 Regular Clinics in the community

31 (25%) Primary Care locations

17 Volunteer drop in sites

Care Closer to Home North Wales: Adult Audiology locations

• Release time of other professionals in the primary care team, particularly GPs.

• Improve access for patients, to enable more people to get specialist professional advice early and in a more integrated care pathway

• Deliver such care close to patients homes, in primary care practices, as part of the primary care team.

• Achieve the above safely and with good levels of stakeholder satisfaction from both patients and clinicians.

Primary Care Audiology: Benefits

• There are currently 9.4 WTE Audiologists working in primary care across 17 clusters (27% of primary care clusters in Wales), although not full coverage in any of those clusters.

• Requirements for national roll out:

• Presentation at National Primary Care Conference.• National NHS Wales Awards winner• In place with recurrent funding at just 2 healthboards, 1 healthboard on temp

basis

Primary Care Audiology: Progress to date

Band WTE / cluster For 64 Clusters

Band 4 0.7wte 45

Band 7 0.7 wte 45

Band 8A 0.25wte 16

Workforce Planning: A change in the mix

• PTPs (Swansea Univ) - Fewer

• STPs (Manchester) - More

• Fastrack Science Graduate Band 4s (Swansea) - More

• Band 4 to 5 conversion (Swansea Univ) – New

• Clinical Scientist (support for equivalency) – More

Primary Care Audiology: Lining Up the Ducks for National Roll Out

• Test of concept by Audiologists

• Recognition of merits at health boards through to approval of business cases (3/7)

• Availability of workforce

For full article use link to SBUHB intranet site: http://abm.cymru.nhs.uk/intranet/bulletin.php?bulletin_id=12446

National Recognition:

ABMU HB Primary Care Service – Highly Commended, Healthcare Transformation Awards 2018.

BCU HB Primary Care Audiology Team – Winners, NHs Wales Awards 2018, Category: Innovative use of workforce

BCU HB Primary Care Audiology Team – Finalists, Advancing Health care Awards 2019: Service Innovation Category

If we cannot roll out a nationally celebrated model across Wales it would

reflect poorly on the whole system.