Hearing Aids Under Threat 3 Letter to WFCCG 20th May 2016

20th May 2016

Freepost Plus RTCU-KZKZ-EJZZ

NHS S Worcestershire CCG

The Coach House

John Comyn Drive,

WORCESTER

WR3 7NS

Dear CCG Board Members,

Help shape the future of healthcare services in Worcestershire

Open letter to whom it may concern

With reference to the above survey I wish to make the following points:

• Brief explanations of medical conditions and their likely impact - although laudable - do not go far enough to elicit properly considered responses.
• People often do not appreciate the true impact that medical conditions have on others.
• Figures quoted for services appear to be the total amount of money spent on those services.  
• The implication is that those are the amounts that could be saved when clearly they are not if only parts of the services in question were cut.
• With particular reference to question 3 - which asks whether or not people with mild hearing loss should be denied hearing aid provision - I wish to make the board aware of the following points:
• Mild hearing loss in itself is a fairly meaningless diagnosis.
• It depends upon which frequencies are affected.
• Age related hearing loss tends to affect the higher frequencies.
• Consonants are voiced at higher frequencies than vowels.  
• It is consonants that give speech its meaning.
• The impact of hearing loss is very individual.
• I have it on good authority from a senior audiologist that two patients could be assessed as having the same hearing loss but that the impact of that hearing loss on those two individuals could be wildly different.
• This means that measuring thresholds at which people can hear certain frequencies is not enough to determine whether or not someone could benefit from hearing aids.
• People can experience more/less success when listening to different people.
• This is NOT ‘selective’ hearing in the way that is often joked about.
• It IS ‘selective’ in that different people speak at different frequencies and therefore are more/less understandable depending on the frequencies with which patients have a problem.
• Eg, People with high frequency loss can often determine men’s  speech better than women’s because men tend to have lower pitched voices than women. There are always exceptions to this, however.
• The exhausting nature of hearing loss should not be underestimated.  
• It is extremely tiring for the brain to have to fill in the gaps left by hearing loss.  
• Imagine many of the consonants missing from a conversation.  
• It can lead to people distancing themselves - or being distanced by others - from conversations, becoming isolated, depressed and even leading to accelerated development of dementia.
• Many people with good hearing become frustrated if asked to repeat things for people who have not heard/understood the first, second and possible subsequent times.
• Do not assume that those who nod and smile have understood what you have said.  It is highly likely they may be too embarrassed to ask for further repetition.
• Current advice is that people should seek help with hearing loss sooner rather than later before the difference between noise levels heard with and without hearing aids becomes too great for patients to cope with.
• Department of Health & NHS England Action Plan on Hearing Loss (23rd March 2015) states that Objective 2 (Page 20) is to “ensure that all people with hearing loss are diagnosed early …… and that they are managed effectively once diagnosed.”  
• Page 22 states, “Hearing is a major factor in maintaining independence and achieving healthy ageing.”
• The link between hearing loss and dementia is also mentioned.  There is a  recognised pathway - hearing loss - isolation - depression - dementia.
• It takes - on average - 10 years for people to address their hearing loss.  When they finally admit that they need help it is because they NEED help.
• No one wants to wear hearing aids.
• There is still a certain stigma attached to wearing hearing aids that has to be overcome by the patient.
• Those who benefit from and persevere with hearing aids do so because their lives are more tolerable with than without.

I understand that the government is cutting your budget and that savings have to be made. However, please consider the perceived savings you may make - in denying hearing aids to those patients for whom some arbitrary scoring system has determined a level of hearing loss  - and compare it with the likely expense of dealing with possible health, quality of life and independence problems that could ensue if patients continue along the pathway -  hearing loss, isolation, depression and accelerated development of dementia.

I suffer from hearing loss and whilst there are certain strategies that can be employed to help with speech understanding the overwhelmingly successful one is my NHS pair of hearing aids.  I also have a badly arthritic knee which gave me pain 24/7 until I tweaked my lifestyle.  As a result of eating more of the right things, fewer of the wrong things, using a pedometer and reducing my weight to within half a stone of the minimum recommended for my height my knee is now largely pain free - most of the time.  My lifestyle helps me to ‘manage’ other musculoskeletal problems, too.  Sadly, this lifestyle tweak effected no improvement in my hearing. Hearing aids are my lifeline, socially and in my voluntary work.  They will be a lifeline to others, too.

Please allow audiologists - together with their patients - to decide who will benefit from and be fitted with hearing aids.  Similarly, patients suffering from other medical conditions should be assessed on an individual basis rather than as members of a nebulous, predetermined group.

Yours sincerely,

Kathleen Hill