FREEDOM OF INFORMATION ACT 2000 Dudley CCG: Adult Hearing Services (linked to former FOI RFI0598) - Ref: RFI0705

Transcription

1 Freedom of Information Team Dudley CCG 2nd Floor, Brierley Hill Health and Social Care Centre Venture Way Brierley Hill DY5 1RU Response by 10 May 2017 FREEDOM OF INFORMATION ACT 2000 Dudley CCG: Adult Hearing Services (linked to former FOI RFI0598) - Ref: RFI0705 Thank you for your request received 11 April You asked for information regarding the above. Your request for information has now been considered. I will answer your queries below: 1 In response to question 3 and 6 in the attachment. It states All providers were paid on a cost-per-case basis as per national tariff price. This either suggests an error or misunderstanding. a. Do you mean the AQP tariff or something else? (i.e. please answer questions 3 and 6 again). AQP tariff is applied to all hearing aids for age-related hearing loss, and a locally agreed tariff is applied to all hearing aid activity undertaken within the community contract. b. Please provide a copy of the prices that were paid, include any variation i.e. if you paid different providers differently please explain that here (i.e. reconfirm answer to number 4 and 7 again once you have clarified answers to q3 and 6). AQP Tariff: Hearing Aid Assessment Monaural Pathway Binaural Pathway Hearing Aid Aftercare Replacement Hearing Aids Community Audiology: per contact All above tariffs relate to Chair: Dr David Hegarty MBE Chief Executive Officer: Mr Paul Maubach

2 AQP tariff applies to age-related hearing loss only, therefore a different tariff is applied in some instances to the same provider for hearing aids if the patient requires treatment but this doesn t relate to age-related hearing loss. In this instance a locally agreed tariff for community audiology is applied where the patient attends Dudley Group NHS Foundation Trust. 2 In response to question 8, it is suggested that all patients not eligible for the AQP service are seen by the consultant led adult hearing aid service. All patients who are not eligible for the AQP service are seen either through the Community Audiology service or consultant-led ENT service within the Acute trust. a. Please provide a service specification for this service. Please find attached the Dudley Clinical Commissioning Group Audiology Service Specification. b. Please state how much the CCG paid for this complex adult hearing aid service in 2016/17. If you cannot separate ENT tariffs ignore this, and instead focus on all reimbursement for adult hearing aid services for example any payments paid for hearing aids, direct access audiology etc. The community audiology service cost for 2016/17 was 795,426. We are unable to separate any adult hearing costs within ENT PbR (payment by resuls) tariff. 3 In response to questions 4, 7 and 9 in the attachment. It is claimed the CCG does not have this information. However the CCG pays different rates for AQP and non-aqp work. So a. Please use invoice data to answer question 4 % proportion AQP 27% Community Audiology 73% The above table shows the %proportion of contacts for Audiology for both AQP and community audiology. We are unable to determine the number of contacts seen within ENT for hearing aids. Chair: Dr David Hegarty MBE Chief Executive Officer: Mr Paul Maubach

3 b. To answer question 7, please state number of hearing aid pathways/activity each of the listed providers (in question 5) claimed for based on AQP tariffs and/or other tariffs. Complete Price Eyewear Ltd Dudley Group of Hospitals NHS FT Scrivens Specsavers Total Hearing Aid Assessment Monaural Pathway Binaural Pathway ,717 Hearing Aid Aftercare ,559 1,277 3,161 Replacement Hearing Aids Community Audiology Contacts ,713 15,713 The above activity is for 2015/16. Dudley Clinical Commissioning Group does not hold the data for The Royal Wolverhampton NHS Foundation Trust; therefore I recommend that you contact the Trust directly via: Freedom of Information Coordinator Governance & Legal Services Department The Royal Wolverhampton NHS Trust New Cross Hospital Wolverhampton WV10 0QP or rwh-tr.foi@nhs.net c. Please use invoice data to answer question 9. We are unable to determine the total number of adults fitted with hearing aids outside of AQP pathways, therefore cannot provide a % proportion of adults fitted with hearing aids through AQP. Any queries or concerns, or are dissatisfied with the handling of your request please contact the Director of Communications & Public Insight at Dudley CCG, Brierley Hill Health & Social Care Centre, Venture Way, Brierley Hill DY5 1RU. The contact telephone number is or alternatively Laura.Broster@dudleyccg.nhs.uk. Chair: Dr David Hegarty MBE Chief Executive Officer: Mr Paul Maubach

4 You can also refer to the Information Commissioner at: Information Commissioner s Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Telephone: or Helpline: Yours sincerely Matthew Hartland Chief Operating & Finance Officer Chair: Dr David Hegarty MBE Chief Executive Officer: Mr Paul Maubach

5 SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification No. C01 - Audiology Service Audiology Commissioner Lead Mark Curran Provider Lead Ruth Delves/Tina Harris Period 1 April March 2018 Date of Review October Population Needs 1.1 National/local context and evidence base Best practice followed to British Society of Audiology (BSA) and British Academy of Audiologists (BAA) protocols and procedures in diagnostic Audiology. The hearing aid service provision for adults follows the national Modernisation of Hearing Aid Services (MHAS) best practice guidance and the Modernisation of Children s Hearing Aid Services (MCHAS) for paediatrics. The Newborn Hearing Screening programme (NHSP) from the screening to diagnostics follows the Medical Research Council NHSP best practice guidance. 2. Outcomes 2.1 NHS Outcomes Framework Domains and Indicators Domain 1 Domain 2 Domain 3 Domain 4 Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill-health or following injury Ensuring people have a positive experience of care Domain Locally Defined Outcomes 3. Scope Treating and caring for people in safe environment and protecting them from avoidable harm Digital hearing aids fitted for clinically appropriate patients Diagnostic tests completed and reports provided to referrers. Neonatal hearing screening programme completed within the timeline nationally required and children with a permanent hearing Impairment are identified early and treated appropriately. 3.1 Aims and Objectives of Service Service Model Clinic based community Audiology model for adults and children, with acute/secondary care in reach to support ENT OPD clinics. Audiology support to the Community ENT service with direct referral pathways for appropriate patients who meet each service s referral criteria including procedures outlined in the Procedures 1

6 of Limited Clinical Priority Policy. Diagnostic Audiology Provide a comprehensive diagnostic audiology service to including complex investigations on neonates, paediatric and adult patients of all ages and abilities. Provide coordination, leadership and support to the hospital Newborn Hearing Screening programme in Dudley. Hearing Aid Service Provide an NHS hearing aid service that includes the assessment, programming and fitting of digital hearing aids and the repairs/maintenance of all types of NHS hearing aids and the provision of batteries. In addition the provision of a tinnitus counselling service to a number of referrals per year, including the fitting of hearing aids and noise generators. Ear Nose and Throat OPD support. Support is provided to the Ear Nose and Throat (ENT) services in Dudley in both the Acute and the Community OPD clinics via an SLA. Provide a Direct referral pathway between Audiology and Community ENT service following the services referral criteria. To enable a second opinion or to transfer inappropriate patients seamlessly between services. Objectives To maintain electronic data records for all patients referred to the service for diagnostics or treatment. To improve the quality of life for patients with a hearing difficulty and those requiring a hearing aid. To provide a Direct referral pathway between Audiology and Community ENT service following the PLCP referral criteria. To enable a second opinion or to transfer inappropriate patients seamlessly between services including rejection to Primary Care of referrals that do not meet PLCP referral criteria. To work in partnership with commissioners in order to meet the 18-weeks referral to diagnostic and treatment target. To deliver training, in house or through external courses to ensure existing staff are regularly up dated on all aspects of their role. 3.2 Service Description/Care Pathway Pathways Direct referral pathways for appropriate patients between Audiology and Community ENT service in accordance with the PLCP Policy criteria referral where appropriate Care Pathways Diagnostic pathways for adults and paediatrics work within multi-discipline and multi-agency pathways. The hearing aid provision pathways for adults and paediatrics work within multi discipline and multi-agency pathways. Evidence Based Practice The service adheres to the British Academy of Audiology professional guidelines developed through Best Practice, and modernisation of hearing aids services National Protocol for Children and Adults (NHAS) 2

7 Joint Working Newborn Hearing Screening programme, multi discipline and agency, across Acute, Community Education and Social Care. Paediatric hearing aid provision including Education and Social Services. Adult Hearing aid provision with social Services for the Hearing impaired. Secondary and Community ENT services. 3.3 Population Covered Patients registered with Dudley CCG General Practices. 3.4 Any Acceptance Criteria and Thresholds Paediatrics and adults can access the service from Newborn through to any age. Home visits arranged for fully housebound patients with GP approval. Newborn hearing screening and diagnostic information booklets available in majority of languages. Local hearing aid service information booklets 3.5 Interdependences With Other Services/Providers Secondary and community care ENT, Health Visitors, NICU and maternity staff for newborn hearing screening, training and updates for school nurses, close liaison with social services and education. British Academy of Audiologists Professional Clinical Services Part of the national Audiology patient database Auditbase User Group. MRC Newborn Hearing Screening Programme (NHSP) national group Dudley Public Health Antenatal, neonatal and Child Health group. Children s Hearing Services Working Group (Dudley) multi-disciplinary and multi-agency group. 3.6 Referral Route Diagnostic Audiology Children and young people up to their 19 th birthday, who have a Dudley GP or through agreed contract, can be referred by their GP, health professional and Education etc. with parent s permission, or directly by parents or they can self-refer for a hearing test. Adults from their 19 th birthday, who have a Dudley GP or through agreed contract, can be referred by their GP for a hearing test. Acute or Community ENT services can refer neonates, paediatrics or adults to the Audiology service. Tinnitus Service These patients are seen by the Audiology service and this area of work is generated by the referrals from the Acute ENT service at Russell s Hall Hospital or by the Community ENT service. The patients receive the service through a mutually agreed number of appointments providing self-help information and a greater understanding of the problem they live with. Only patients having had an ENT Consultation are able to be referred. Hearing Aid Service Children must be referred from an Ear Nose and Throat Consultant to be fitted with a hearing aid. Adults must be referred from an Ear Nose and Throat Consultant to be fitted with a hearing aid or by their GP who can make a referral to the Audiology Service using very strict Direct Referral criteria. Any NHS hearing aid wearer, adult or child can continue to access the service via self-referral for an appointment or through the open access booked repair provision for routine maintenance or repairs to digital or analogue hearing aids. The Service operates to locally agreed referral guidelines for accepting patients from GP 3

8 Practices. Discharge Arrangements Patients are discharged from the service once treatment and follow up is complete. Patients are assessed on an individual basis to ascertain the need for on-going follow up. Patients with an NHS hearing aid remain on the caseload in order to enable self-referral into the service as required. User Friendly Environment The Service provides an environment which is conducive to all age groups, with an identified separate play area for young children and consideration to easy and safe access for the elderly. Referrals Referrals are required to be made electronically from GPs. 3.7 Response Times and Prioritisation Diagnostic Audiology Waiting Times Any patient that is identified as a priority will be dealt with within the 1 to 4 week urgent guidance. Diagnostic audiology has a target of referral to first non-urgent appointment within 6 weeks. Waiting List Management Adult Diagnostic Audiology Onward referrals from the ENT and Community ENT Departments are entered on to the waiting lists at the date of referral received into the Audiology Department. All direct referrals into Audiology will be entered onto waiting list from date of referral 18 week referral to treatment maximum wait. 1.1 Urgent Criteria Patients URGENT CRITERIA maximum 2 weeks from date of referral Registered Blind - proof of registration required Short life expectancy - a Consultant or GP referral advising of this situation may be sufficient information. If information on short life expectancy is received from patient or relative etc. only, GP advice is required. DIRECT REFERRALS CROSS-REFERRED TO ENT Where a patient has been cross referred to ENT re a clinical decision, no further action (NFA) will be taken on the waiting list position for any further Audiology treatment until the receipt of an ENT referral letter of request. On receipt of a referral via this route, the patient will be treated as a new patient and waiting list entry will be according to the ENT referral date. The service has a separate waiting list policy for domiciliary visits. Hearing Aid Service Hearing aid service has waiting times as follows: Paediatric 2 weeks from pre-assessment diagnosis or as agreed with parents New Adult Patients 18 week RTT pathway Replacement of analogue hearing aids with digital hearing aids (patients self-refer) 4

9 (waiting time to be within the 18 week RTT) Permanent Childhood Hearing Impairment (PCHI) Where parents agree, hearing aids will be fitted within 2 weeks of confirmation of a hearing loss, depending on parents agreement through informed decision. Following loss or damage of a Child s hearing aid(s), a replacement hearing aid of the same make and model with programmed settings as last recorded will be fitted. This will be within 2 weeks of notification. 3.8 Transfer and Discharge from Care Obligations Discharge Arrangements Patients are discharged from the service once treatment and follow up is complete. Patients are assessed on an individual basis to ascertain the need for on-going follow up. Patients with an NHS hearing aid remain on the caseload in order to enable self-referral into the service as required. 3.9 Self-Care and Patient and Carer Information Hearing aid leaflets, a booklet on local hearing aid services in Dudley and information leaflets on further hearing and balance investigations are provided to patients and carers. Multi lingual, New born hearing screening booklet are also available 3.10 Geographic Coverage/Boundaries/Exclusion Criteria Patients not registered with a Dudley CCG GP Relevant Networks and Screening Programmes British Academy of Audiologists Professional Clinical Services Part of the national Audiology patient database Auditbase User Group. MRC Newborn Hearing Screening Programme (NHSP) national group Dudley Public Health Antenatal, neonatal and Child Health group. Children s Hearing Services Working Group (Dudley) multi-disciplinary and multi-agency group Sub-contractors Suitably qualified agency staff used occasionally. Audiology Bank of NHS qualified staff in other Primary Audiology positions within the Region 4. Applicable Service Standards 4.1 Applicable National Standards (e.g. NICE) Not applicable. 4.2 Applicable Standards Set Out in Guidance and/or Issued by a Competent Body (e.g. Royal Colleges) Not applicable. 4.3 Applicable Local Standards Based on National, locally based, audiology system Ethnic coding on the Audiology Auditbase patient management system is now available and therefore the information will be used to produce a report according to the Audiology audit plan Hearing aid service has waiting times as follows: Paediatric 2 weeks from pre-assessment diagnosis for newly diagnosed patients or as 5

10 agreed with parents New Adult Patients 18 week RTT pathway Replacement of analogue hearing aids with digital hearing aids (patients self-refer) (waiting time to be within the 18 week RTT) Permanent Childhood Hearing Impairment (PCHI) Where parents agree, hearing aids will be fitted within 2 weeks of pre-assessment diagnosis, depending on parents agreement through informed decision Following loss or damage of a Child s hearing aid(s), a replacement hearing aid of the same make and model with programmed settings as last recorded will be fitted. This will be within 2 weeks of notification Diagnostic Audiology Waiting Times Any patient that is identified as a priority will be dealt with within the 1 to 4 week urgent guidance. Diagnostic audiology has a target of referral to first non-urgent appointment within 6 weeks. Waiting List Management Adult Diagnostic Audiology Onward referrals from the ENT and Community ENT Departments are entered on to the waiting lists at the date of referral received into the Audiology Department. All direct referrals into Audiology will be entered onto waiting list from date of referral. 18 week referral to treatment maximum wait. 1.1 Urgent Criteria Patients URGENT CRITERIA maximum 2 weeks from date of referral 5. Applicable Quality & Information Requirements and CQUIN Goals 5.1 NHS Outcomes Framework Domains and Indicators Quality Requirement Maximum Community Waiting Times Audiology Non Urgent Maximum Wait Adult Diagnostic From date of referral Maximum Community Waiting Times Audiology Non Urgent Maximum Wait Adult Treatment From date of referral Maximum Community Waiting Times Audiology Non Urgent Maximum Wait Paediatric Diagnostic Method of Threshold Measurement / Frequency <=6 weeks Reported achievement via <=18 weeks Reported achievement via <=6 weeks Reported achievement via Consequence of Breach From date of referral 6

11 Maximum Community Waiting Times Audiology Non Urgent Maximum Wait Paediatric Treatment From date of referral Maximum wait for hearing aid: Paediatric 2 weeks from pre-assessment diagnosis Maximum wait for hearing aid: Adult 18 weeks from date of referral.(including replacement of analogue hearing aid with digital hearing aid patient selfreferrals) Maximum waiting time for paediatric replacement hearing aid (Same make and model); 2 weeks <=18 weeks Reported achievement via 80% Reported achievement via 95% Reported achievement via. 95% Reported achievement via (All paediatrics in full time education) 5.2 Applicable Information Requirements Not applicable 6. Availability of Service 6.1 Location of Provider Premises Location(s) of Service Delivery The Audiology service for neonates, Paediatrics and adults is predominately delivered from the purpose built Audiology Department at the Brierley Hill Health and Social Care Centre but to a limited extent it can also be delivered from patient s homes. Acute and community ENT settings. Adult Diagnostic Audiology The Audiology service is provided from a purpose built Audiology Department at Brierley Hill Health and Social Care Centre and also on a smaller scale at the Audiology Suite Russell s Hall Hospital and Stourbridge Health and Social Care Centre (ENT Department). A limited provision can be offered as a domiciliary service to the housebound for hearing assessments and hearing aid provision. This is a strictly controlled service requiring the GP to approve the request. Diagnostic support is provided at the ENT OPD at Russell Halls Hospital for Dudley Group of Hospitals through a SLA, and the Stourbridge Health and Social Care Centre for community ENT. Paediatric Diagnostic Audiology The paediatric service is provided to Neonates along with the Pre-school and school age children, the diagnostic tests are conducted in the Audiology Department at the Brierley Hill Health and Social Care Centre, children s centres and in the Audiology suite at RHH for further investigations as necessary. 7

12 Hearing Aid Service All Audiological measurement and hearing aid fitting activity for Adults and Paediatrics is conducted in the purpose built Audiology Department at the Brierley Hill Health and Social Care Centre or as a limited service in the patient s home if housebound. The service will also attend day centres, hospital inpatients and Busheyfields if there is patient need. The Hearing Aid Repair Service is provided from purpose built Audiology Department at the Brierley Hill Health and Social Care Centre. or in the patients home if housebound Hearing aid battery replacements are provided at Brierley Hill Health & Social Care Centre and are available via post for all patients registered to Dudley Group NHS Foundation Trust Audiology Department. Hearing rehabilitation and tinnitus counselling and therapy are provided at the purpose built Audiology Department at the Brierley Hill Health and Social Care Centre. Infection Control The service adheres to the CCG policies in these areas including: Trust glove policy and Essential steps to safe, clean care. 6.2 Number of Sessions Provided at each Location There are 10 sessions per week. 6.3 Days/Hours of Operation Diagnostic Audiology 7.45am 12.30pm, 1.15pm 6.00pm Monday Thursday (5.30pm Friday) Any domiciliary visits will be undertaken within normal service working hours. The Hearing Aid Repair Service There is a hearing aid repair service (Monday to Friday at the times above) based at to the Brierley Hill Health and Social Care Centre. All times exclude bank holidays. There is no out of hours service 7. Individual Service User Placement (if applicable) Version control Version Number Date agreed Detail of Change Amendments from Dudley CCG Amendments as agreed at CWG Final version agreed by DGFT & CCG 8