Friday 24 March 2017

Plea to CCGs re NHS Hearing Aids



Dear CCG Governing Body  Members,

Proposal to limit NHS hearing aid provision
Open letter to whom it may concern
Updated 15th June 2017

With reference to your proposal to limit the provision of NHS hearing aids please consider the following:
  • People often do not appreciate the true impact that hearing loss can have on others.
    • '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. Please see WHO advice here: http://www.who.int/pbd/deafness/hearing_impairment_grades/en/ "Note: While audiometric descriptors may provide a useful summary of an individual’s hearing thresholds, they should not be used as the sole determinant for the provision of hearing aids. The ability to detect pure tones using earphones in a quiet environment is not in itself a reliable indicator of hearing disability. Audiometric descriptors alone should not be used as the measure of difficulty experienced with communication in background noise, the primary complaint of individuals with hearing loss."
    • 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.  
  • Hearing Loss can lead to people distancing themselves - or being distanced by others - from conversations, becoming isolated, depressed and experiencing 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.  
    • ‘Managing’ without hearing aids should be actively discouraged.  https://bliss2hear.blogspot.co.uk/2017/01/manage-without-hearing-aids-many-many.html
    • I have spoken with many people who are reluctant to wear their hearing aids.
      • Almost without exception one of the reasons is that they find the world too noisy.
      • Their hearing has deteriorated too much before they sought or were offered help.
  • According to Action on Hearing Loss 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.  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.  
Yours sincerely,
Kathleen Hill
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of Wyre Forest Patient Participation Groups (PPGs)
Member of NHS Wyre Forest CCG Membership Scheme
Twitter @kathleenlhill                                 

Updated 15th June 2017             

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