Universal Hearing Health Care: United Kingdom One in five adults in the United Kingdom (UK) has a bilateral hearing loss of 25+ dB HL or more. To meet the needs of people with hearing loss, the National Health Service (NHS) funds the Adult Hearing Service (AHS) and the Children’s Hearing Service (CHS). These programs provide 600,000-plus ... World Beat
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World Beat  |   December 01, 2008
Universal Hearing Health Care: United Kingdom
Author Notes
  • Adrian C. Davis, PhD, is director of the MRC Hearing and Communication Group at the University of Manchester and director of the NHS Newborn Hearing Screen Programme. Contact him at adrian@mrchear.man.ac.uk.
    Adrian C. Davis, PhD, is director of the MRC Hearing and Communication Group at the University of Manchester and director of the NHS Newborn Hearing Screen Programme. Contact him at adrian@mrchear.man.ac.uk.×
Article Information
Hearing & Speech Perception / Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / World Beat
World Beat   |   December 01, 2008
Universal Hearing Health Care: United Kingdom
The ASHA Leader, December 2008, Vol. 13, 16. doi:10.1044/leader.WB4.13172008.16
The ASHA Leader, December 2008, Vol. 13, 16. doi:10.1044/leader.WB4.13172008.16
One in five adults in the United Kingdom (UK) has a bilateral hearing loss of 25+ dB HL or more. To meet the needs of people with hearing loss, the National Health Service (NHS) funds the Adult Hearing Service (AHS) and the Children’s Hearing Service (CHS). These programs provide 600,000-plus hearing aids to up to half a million people. These services are provided at about 150 hearing aid centers in the UK. The AHS also repairs more than 1.5 million hearing aids per year. Providing “end-to-end” care costs approximately $356 million (£150 million) annually for diagnostic assessments, hearing aid dispensing, and follow-up care, including free batteries.
CHS provides assessments and diagnostic tests for children and support for families. Universal newborn hearing screening was fully implemented in England by the NHS in March 2006 and more than 1,600 babies are screened every day in hospitals in England, Wales, Northern Ireland, and Scotland. The median age of identification has been reduced from 20 months to less than 3 months of age. Follow-up from newborn screening is challenging and dependent on technology, but is integrated into health, education, family support, and social services.
All patients are routinely offered digital hearing aids. To speed up access to fitting and to use audiologists’ time efficiently, one-stop assessment and fitting of digital signal processing aids with generic open earmolds and small-diameter tubes are offered at almost all sites. All hearing aid departments are networked and use computerized audiology patient management systems, linked audiometers, and real ear measurement systems. Patient outcome measures provide an evaluative framework for service development. AHS clinical service pathways recommend one appointment, if possible, usually in a major audiology center, for assessment and fitting of hearing aids, with follow-up, repair, and ongoing counseling offered at convenient locations for patients (Smith, Davis, & Mack, 2008).
The Providers
More than 3,000 NHS audiology professionals work alongside commissioned independent (private) sector audiologists to serve adults. There are also 1,000 or so private-sector audiologists/hearing aid dispensers who provide services to the public outside of the NHS. The UK is working toward a joint scope of practice for NHS and independent-sector audiologists, but this has not been finalized.
As part of the Modernizing Hearing Aid Services, an extensive professional training program was developed. A four-year bachelor of science program in audiology has produced its second cohort of graduates, and master’s and post-graduate audiology programs are available. Employment in the NHS in a substantive post as an audiologist usually requires a bachelor’s degree in audiology or equivalent. Registration as an audiologist with a recognized professional body requires a certificate of audiological competence. The training, qualification, competence, and registration of audiologists is currently being reviewed as part of an initiative to update scientific careers in health care in the UK.
NHS is responsible for commissioning and funding the full range of health services, including hearing services. Most NHS hearing services are located in NHS acute care hospitals, although some services for children are provided through community outreach. In the next few years, increased presence of audiologists in community health clinics and shopping areas will improve access. Independent-sector provision has grown over the last five years, with some involvement in NHS through a public-private partnership.
Wait Times Improved
The increased time needed to fit and program digital hearing aids has contributed to long waiting times for services. The waiting time for an audiological assessment is now within six weeks, on average, the same as that of any other diagnostic test for which data is collected. Most hearing aid departments are fitting hearing aids within 18 weeks of referral from family doctors. A major problem is a lack of capacity in audiology, which is not unique to UK. Over the past few months, improvement has been made and the target maximum of 18 weeks between referral and hearing aid fitting is now a reality.
Future Needs
Older people make up a large proportion of hearing aid users. The median age of adults presenting with hearing loss has increased from about 70 years in the early 1980s to about 74 years in 1999. The high prevalence of hearing loss among older adults provides a justification for routine hearing screening, if effective and acceptable methods can be found.
Recent research for the NHS Health Technology Programme (Davis et al., 2007) suggests that screening 55- to 74-year-olds can provide outcomes that make a measureable difference in their quality of life. The study of more than 35,000 people found that 12% had a hearing loss, but only 3% had hearing aids. These results suggest that systematic screening could be beneficial and cost-effective for people 55–74 years old who are unlikely to self-refer.
We are very proud of our program in the UK. We have made every effort to be all-inclusive, offering services to every resident, while measuring and ensuring quality and excellent standards of care at a reasonable price within the well-defined parameters of health care requirements, budget, and demand.
Adult Hearing Service: By the Numbers

Funded by National Health Service (NHS), Adult Hearing Services provides at least 2.6 million appointments per year which include:

  • 1 million or more “repair” appointments, such as providing new tubing for hearing aids

  • 600,000 assessments, including new patients and reassessments

  • 500,000 hearing aid fittings in one or both ears

  • 500,000 follow-up appointments to ensure that aids are working

  • 100,000 appointments for hearing care such as cerumen management

  • Support and counseling during visits

References
Davis, A., Smith, P., Ferguson, M., Stephens, D., & Gianopoulos, I. (2007). Acceptability, benefit and costs of early screening for hearing disability: A study of potential screening tests and models. Health Technology Assessment, 11(42). http://www.hta.ac.uk/project/1025.asp or http://www.18weeks.nhs.uk.
Davis, A., Smith, P., Ferguson, M., Stephens, D., & Gianopoulos, I. (2007). Acceptability, benefit and costs of early screening for hearing disability: A study of potential screening tests and models. Health Technology Assessment, 11(42). http://www.hta.ac.uk/project/1025.asp or http://www.18weeks.nhs.uk.×
Smith, P., Mack, A., & Davis, A. (2008) A multicenter trial of an assess-and-fit hearing aid service using open canal fittings and comply ear tips. Trends in Amplification, 12(2), 121–136. [Article] [PubMed]
Smith, P., Mack, A., & Davis, A. (2008) A multicenter trial of an assess-and-fit hearing aid service using open canal fittings and comply ear tips. Trends in Amplification, 12(2), 121–136. [Article] [PubMed]×
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December 2008
Volume 13, Issue 17