FREEDOM OF INFORMATION DECISION NOTICE. FOI Reference Number: 999

Transcription

1 Scarsdale Nightingale Close Newbold Chesterfield S41 7PF Tel.: Date: 7 January 2019 FREEDOM OF INFORMATION DECISION NOTICE Dear Sir / Madam, FOI Reference Number: 999 I refer to your of 5 December 2018 requesting information in respect of audiology. I can confirm on behalf of Erewash, Hardwick, rth Derbyshire and Southern Derbyshire CCGs, and in accordance with S.1 (1) of the Freedom of Information Act 2000 (FOIA) that we do hold some of the information that you have requested. A response to each element of your request is detailed below: I am writing, under the Freedom of Information Act, to request information in regard to the commissioning of adult audiology services by your CCG. We are aware that CCGs commission services rather than directly provide them. As well as finding out about service provision, we would also like to understand more about the information CCGs hold about the services they commission. We anticipate that CCGs will hold much of the information that we are requesting in order to commission effective services and monitor performance. Part of this exercise is to find out whether CCGs hold enough information to properly hold their providers to account and to make informed commissioning decisions to meet the needs of their local population. Please therefore provide any information that you hold. Please do not direct us to a provider trust. Please respond by selecting the relevant answer option at each question by placing an X in the box, or by providing the information requested in the question. 1. Name of CCG: Erewash, Hardwick, rth and Southern Derbyshire CCGs. 2. Are any of the adult hearing services provided though Any Qualified Provider (AQP) in your CCG area? Yes Yes If yes please state how many providers 6

2 3. Do you have a policy on the implementation of the NICE guideline Hearing loss in adults: assessment and management when providing adult audiology services? Yes. Derbyshire Clinical Policies Affiliated Group (CPAG) are currently reviewing the NICE guidance and writing a policy. 4. Do you hold information on the following for your CCG area: Your audiology spend in 2015/16 Your audiology spend in 2016/17 Your audiology spend in 2017/18 Your planned spend in 2018/19 Your planned spend in 2019/20 (if known) Spend on adult audiology Spend on child (paediatric) audiology Total audiology spend Comments (Please clarify if this is complete data for the CCG, or just from a sub set of providers) NOTE 1: Please fill in as much as you can. If, for example, you cannot provide a breakdown between adult and child services, please just fill in the TOTAL fields. NOTE 2: Please present all these figures in nominal terms. We do not hold this information broken down to adults and children. Please see below total audiology spend per CCG. We do not currently hold information regarding planned spend in 2019/20. SDCCG NDCCG ECCG HCCG 2015/16 3,224,399 1,796, , , /17 2,938,996 2,192, , , /18 3,639,325 1,983, , , /19 3,384,903 2,099, , ,245 (Estimated) Total 13,187,622 8,072,410 1,967,514 2,027, a) How many hearing aid fittings took place in the services you commission in each of the following years for adults. NOTE 1: we are not asking for patient identifiable data, we just want the number of fittings. NOTE 2: Please fill in as much as you can. However if, for example, you cannot provide a breakdown between adult and child services, or bilateral vs unilateral, please just fill in the total fields or even just the total field or the total table in part c. unilateral fittings (just one hearing aid fitted) bilateral fittings (hearing aids fitted to both Total Comments (Please clarify if this this is complete data for the CCG, or just from a sub set of providers)

3 2015/ / /18 ears) We do not hold this information. The AQP service only applies to adults over the age of 55. b: how many hearing aid fittings took place in each of the following years for children: unilateral fittings (just one hearing aid fitted) bilateral fittings (hearing aids fitted to both ears) Total Comments (Please clarify if this is complete data for the CCG, or just from a sub set of providers) 2015/ / /18 We do not hold this information; it is held by providers. c: how many hearing aid fittings took place in total (adults + children): unilateral fittings (just one hearing aid fitted) bilateral fittings (hearing aids fitted to both ears) Total 2015/ / /18 We do not hold this information; it is held by providers. Comments (Please clarify if this is complete data for the CCG, or just from a sub set of providers) 6. Do you have a hearing loss threshold dbhl, below which adults will not be prescribed hearing aids? Yes please state what the threshold is:. The service specification mentions Assessment of current activity restrictions and participatory limitations - using a formal validated self-report instrument however the contract does not mention dbhl. 7. When adults have an aidable hearing loss in both ears, what is your CCG policy? (Please select the relevant response) Two hearing aids are always offered One hearing aid is offered in the first instance unless someone specifically requests two hearing aids Only one hearing aid is offered We have a restriction in place for fitting

4 hearing aids (please comment) Regarding provision and fitting of hearing aids the service specification within the contract states: Discuss and document whether a unilateral or bilateral fitting is appropriate. Any decision in this respect must be based on clinical need and not financially driven. Bilateral fittings are not clinically appropriate where: One ear is not sufficiently impaired to merit amplification One ear is so impaired that amplification would not be beneficial (and should be referral back to the GP for onward referral to complex audiology or other support services) The patient declines bilateral aiding where offered as appropriate (this should be confirmed in a signed statement by the patient) Other reason (e.g. manipulative ability, otological) 8. Do you commission any hearing screening programme in your CCG area? Yes please provide details. Newborn hearing screening for children is not commissioned by CCGs but by NHS England. 9. For the services you commission please tell us how many Whole Time Equivalent (WTE) audiologists provide (or provided) services to adults? Please include all audiologists, including locums. Currently in 2017/18 in 2016/17 in 2015/16 Number This information is specific to each provider and is not held by the CCG. 10. What is your tariff (or cost) for the following for non-complex adults (please complete table): Description Audiology hearing aid assessment only Pathway for hearing aid assessment, fitting of one hearing aid device, cost of one device and first follow up Pathway for hearing aid assessment, fitting of two Planned tariff 2019/20 Current tariff 2018/19 Tariff 2017/18 Tariff 2016/17 Tariff 2015/16

5 hearing aid devices, cost of two devices and first follow up Hearing aid aftercare (repairs) NOTE 1) Please specify these figures in nominal terms. NOTE 2) If you pay for services in different categories to those set out above, or in different ways, please could you specify. Tariffs of 5 year contract, which Cost commenced April 2017 Audiology hearing aid assessment only 50 Pathway for hearing aid assessment, fitting 100 of one hearing aid device, cost of one device and first follow up Pathway for hearing aid assessment, fitting 200 of two hearing aid devices, cost of two devices and first follow up Hearing aid aftercare (repairs) 25 Prior to the above contract, the tariff below applied:

6 11. Do the services you commission offer a one stop assess and fit service for people with hearing loss? This is a service where hearing aid assessment and fitting takes place on the same day. Yes (If you wish, please provide further details of how this works) Yes. The Direct Access Adult Hearing Service should ensure that two approaches are available to address the assessment and fitting requirements of the pathway: A single assess and fit pathway where suitable, for patients to receive hearing aids at the initial assessment appointment - suitability depends on hearing loss, dexterity, cognitive ability, emotional readiness and patient choice A two stage pathway, where an impression of the ear is taken at the first assessment appointment for an ear mould to be made and the patient returns at a later date for the hearing aid fitting (or bilateral impressions for bilateral fittings) Pre-appointment information should mention the two options, to prepare patients better in advance of having to make this decision. 12. Is any of the following data collected in relation to outcomes from adults using hearing loss services in your area? (Please select all that apply) Continuation with use of hearing intervention provided Reported benefits from hearing intervention Service user satisfaction with their choice of intervention Service user satisfaction with their choice of intervention is collected; the providers are monitored as part of their contract and one of the Key Performance Indicators (KPIs) that they report on is 95% of responses received from patients sampled via

7 a service user survey should report overall satisfaction with the service. Reduced communication difficulties Improved quality of life Other (please specify) 13. Do you publish any of this data? Yes (please specify). 14. Do you use outcomes data as part of your commissioning and monitoring arrangements? Yes Yes. The monitoring KPIs are listed above. 15. Are adult hearing loss services in your CCG area commissioned on the basis of activity (e.g. number of procedures performed) or on the basis of outcome (e.g. patient outcome data)? Please select the relevant option and provide further details: Service commissioned by: (select option) Please specify details of what activity / what outcomes Activity X AQP contract; therefore cost per case. Commissioned on activity. Outcome Combination / other (please specify) 16. What follow-up arrangements are offered to patients who have received a hearing aid fitting from the services you commission? Follow-up appointments are not offered Follow-up appointments are offered to patients who request them Follow-up appointments are automatically offered to all patients Follow-up appointments are automatically offered, but only to some patients (please specify) X 17. If services automatically offer follow-up appointments, do you have any policies or targets in place for the length of time between hearing aid fittings, and follow up appointments? Yes (please specify the length of time) Yes; a KPI that providers report on is 90% of follow-up appointments should be within 10 weeks of fitting.

8 18. Do you hold any data on the actual length of time between hearing aid fitting and first follow up appointment? Yes (please specify the median time in weeks and days). The contract has a KPI that providers report on is 90% of follow-up appointments should be within 10 weeks of fitting but we do not hold any data regarding a median time for these and average/median waiting times may differ per provider. 19. How do the services you commission offer follow-up appointments to patients? (Please tick all that apply) Face-to-face Via telephone Via post/ Other (please specify) X X X 20. Do the services you commission provide audiology clinics out of hours i.e. after 6pm/ before 9am/ at weekends? Yes If yes, please provide any further details here: This information is specific to each provider and is not held by the CCG. 21. We would like to know more about the services you commission and any charges patients may experience. Hearing aid batteries Hearing aid battery postage Replacement for lost hearing aid Ear moulds Tubing We commission services that provide this, and the patient receives it for free Provider covers the cost. Provider covers the cost. The CCG will not fund lost devices, only those that are damaged or faulty. Provider covers the cost. Provider covers We commission services that provide this, but there is a charge. If so please specify the charge and what the patient receives for the charge (e.g. 5 batteries for 5). We do not commission services that provide this. Please go to Q21a.

9 replacement Ear wax removal Hearing aid repair/maintenance the cost. This service is offered by some GP practices within their basket of services; some patients use private providers for ear wax removal. Provider covers the cost. 21a. If the services you commission do not provide this service, please specify how people obtain their hearing aid batteries: t applicable. 22. If you have any comments on the above, or if there are any other charges related to hearing aids or audiology service provision in your CCG area, please specify here further charges are applicable. 23. For patients fitted with hearing aids, in what ways do the services you commission offer re-assessments of their hearing needs after a period of time (please indicate all that apply) Automatically after a certain period of time Patients are offered a review 3 years after fitting but are also offered aftercare and are able to request an ad hoc reassessment before the 3 years if required. On patient request or new GP referral Other (please specify) 24. If services offer an automatic re-assessment, after how many months/years does this take place for non-complex patients? Please specify: 3 years 25. If services offer re-assessment on patient request or GP referral, is there a minimum number of months/years they have to wait before requesting this? Please specify: See q23 I hope that this answers your queries with the information we currently hold, but if I can be of any further assistance please do not hesitate to contact me. If you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within two months of the date of receipt of the response to your original letter and should be addressed to: NHS Derbyshire CCGs FOI Team

10 Scarsdale Nightingale Close Newbold Chesterfield S41 7PF Or: If you are not content with the outcome of your complaint, you may apply directly to the Information Commissioner for a decision. Generally, the ICO cannot make a decision unless you have exhausted the complaints procedure provided by Derbyshire CCGs. The Information Commissioner can be contacted at: Information Commissioners Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF, telephone , casework@ico.org.uk. Yours faithfully, Kathryn Jacklin FOI Officer Southern Derbyshire CCG On behalf of NHS Southern Derbyshire CCG NHS rth Derbyshire CCG NHS Hardwick CCG NHS Erewash CCG All information we have provided is subject to the provisions of the Re-use of Public Sector Information Regulations Accordingly, if the information has been made available for re-use under the Open Government Licence (OGL) a request to reuse is not required, but the licence conditions must be met. You must not re-use any previously unreleased information without having the consent from NHS Erewash CCG, NHS Hardwick CCG and NHS rth Derbyshire CCG. Should you wish to re-use previously unreleased information then you must make your request in writing ( will suffice) to the FOI Lead via Derbysccg.foi@nhs.net. All requests for re-use will be responded to within 20 working days of receipt.