23 June 2015

Roy Lilley Response: Hearing care can be a lifeline for older people and we can do more for less

NHS blogger Roy Lilley recently criticised attempts to ration NHS adult hearing services. Bringing care into the community can help commissioners do more for less and that should be the goal, not cuts, says Oliver Lamb

Roy Lilley recently spoke up against rationing NHS hearing aids. In his NHSManager.net blog Lilley describes sorting through his mother’s belongings after she recently passed away, and discovering her ‘best friends’ – the hearing aids she wore in later life: “Without them life was a blur. With them came clarity, conversation, joining in, debate, laughter, independence and connection to the world… Without them; depression and exclusion.”

When put like this it is easy to understand the difference good care makes to people with hearing loss and why cutting this service is a bad idea. This insight is backed up by research that shows unsupported hearing loss can lead to social isolation, depression and cognitive decline, but with the right support we can offset these risks and improve quality of life.

Lilley has written in the past about how adult hearing care can be effectively delivered in the community, providing a more streamlined and accessible service for older people. Here’s why I agree:

Why Community Hearing Care?

1. Community hearing care keeps people active in their community
   It is often easier for older people to attend a local clinic than visit a hospital. Care closer to home means older people stay connected to local support networks, develop local relationships and maintain their independence.

2. Increased visibility can help reduce stigma around hearing loss
   Age-related hearing loss, the main cause of all hearing loss, is a natural part of ageing. The service tends to be over medicalised because too often it is only delivered in hospital, but there is no reason to do so. The sooner more people get used to seeing hearing care providers (as they see opticians today) the sooner the process of normalisation can begin.

3. Better access can support older people adapt to their hearing aids
   People need ongoing support with hearing aids – without this the devices are more likely to end up in drawers. We know that community providers are delivering timely aftercare and follow up and we know this encourages ongoing use of hearing aids.

Time to get serious about active ageing

If we are serious about wanting to support people as they age, then adult hearing care is clearly an important part of the picture – for example people are still surprised that adult onset hearing loss is the 6th leading cause of years lived with disability in England.

The real tragedy in hearing care is that we have known what to do for over 30 years – more responsive care, better follow-up care and care closer to home, but still we have not achieved this nationally.

Lilley points out at the end of his blog:

“I know CCGs have to make hard choices. That means they have to be clever, not callous, innovative not insensitive.  Bullying is smoke, courage is fire.  Bullies have no brains; making budgets work is the work of the really smart.”

I could not agree more. In hearing care the NHS can do more for less. Monitor recently pointed out that in some regions choice reforms had resulted in savings of 20 to 25% per patient and these could be higher in other areas - yes, close to 10x the efficiency gains called for in the Five Year Forward View! In fact Monitor pointed out that choice reforms – i.e. the introduction of community providers – had  improved standards, transparency and value for money.  Change is still slow though and the service remains predominantly hospital based.

Perhaps this is because of what we focus on. CCGs that threaten to cut services get national coverage, but we don’t hear much about those paying more for less. Worst of all, those that have improved standards, transparency and value for money get no acknowledgment. We don’t see CCGs following peers that have cut marginal costs and are now seeing more people for less, but we hear threats that CCGs will follow peers that cut services.

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Real change will require commissioners to focus on quality and value for money and to work with all providers in an open and transparent way, not to delay or reverse change. It will need “the work of the really smart” as Lilly puts it. But it will also need all of us to praise those that get it right, help support those that don’t know they can do more for less and challenge others that take short cuts.

There have been some positive signs recently, with NHS England and the Department of Health publishing their Action Plan of Hearing Loss  which recognises the importance of supporting people with hearing loss. This time however we must deliver and not let history repeat itself – i.e. no more avoidable system failures. If we succeed, we will help our population to age well, if we fail we fail another generation. As NCHA Chief Executive David Hewlett reiterated last week, it is time to get serious about active ageing and support people with their hearing loss: Roy Lilly’s recent blog adds to the case for change.