Recommendation

Response

1

The Board recommends that NHS Sussex works with GP practices and Primary Care Networks to improve information, public communications and signposting both in surgeries and online, on how and where to access free NHS earwax removal services in East Sussex.

As part of the communications regarding the age-related hearing loss accreditation process, the ICB intends to include information regarding ear wax removal services available in primary care on the public facing website. The ICB will also share this information via the primary care bulletin to make it available to all practices for them to include in their local communications to their patients.

2

The Board recommends that NHS Sussex issues communications to all GP practice employees in East Sussex to make staff aware of the earwax removal pathway and confirm that they should not be referring patients to private provision.

NHS Sussex issued a letter to all practices in March 2025 reminding them of the ear wax removal pathway and that patients can be referred to NHS-funded services.

3

The Board recommends that NHS Sussex responds (if it has not already) to the recommendations made by Healthwatch in its report ‘Experiences of Earwax Removal’, published in July 2024, and that the responses are shared with HOSC.

The Locally Commissioned Service (LCS) for primary care was launched in July 2022 and the Healthwatch survey was undertaken during 2023/24. Since then, there has been growing awareness of the service and improvements have been made, including establishing inter-practice referral pathways. In line with Healthwatch recommendations, NHS Sussex regularly audits the LCS activity, contacting individual practices where activity is outside expected thresholds and require inclusive practices that mitigate the impact of health inequalities, such as offering translation services.

4

The Board recommends that NHS Sussex confirms with all GP practices in East Sussex that if they are unable to provide earwax removal services that they should be referring patients to other nearby GP practices that do provide regular earwax removal appointments.

As above, an annual reminder was sent to all practices in March 2025 regarding the inter-practice referral pathway. The next annual roundup for primary care is due to be published in March 2026 and will include reference to the ear wax removal LCS.

5

The Board recommends that NHS Sussex explores benchmarking of activity and uptake of earwax removal services to monitor if it reflects local age profile and expected activity levels and take appropriate action to address any identified gaps in provision.

There are individual thresholds for practices according to their practice population, registered list growth, previous years’ activity, and whether they receive referrals from other practices; NHS Sussex liaises with practices accordingly as part of their regular auditing activity and looks at activity Sussex-wide to identify unwarranted variation.

6

The Board recommends that NHS Sussex works with Primary Care Networks and Integrated Community Teams to explore the viability of earwax removal ‘hubs’, while recognising the limitations of such a delivery model in some parts of the county, particularly rural areas.

There are no current plans for a dedicated hub to provide ear wax removal services due to the dispersed nature of the East Sussex patient population.  NHS Sussex continues to work with providers to review any improvement opportunities, including whether there is a case for a dedicated hub model of service delivery that could improve patient access requirements in an affordable and sustainable way.

Recommendation

Response

7

The Board recommends that NHS Sussex facilitates cooperation between GP practices, PCNs, VCSE organisations and the new contract holder to create simple and effective referral pathways for patients needing earwax removal prior to a hearing assessment.

Integration with other services is a key feature of the service specification and the assessment criteria. The topic of integration with interdependent services will also be added as an agenda item in the contract review meetings once the new service specification is in effect. The Planned Care and Primary Care commissioning teams are also liaising more closely around this interdependent pathway to keep each other informed of service developments and facilitate cooperation between services.

8

The Board recommends that NHS Sussex works with Public Health to further understand barriers to people using hearing aids once they have been provided with them, including access to aftercare and maintenance.

The new Key Performance Indicators will measure % of those who are still using their hearing aids at the annual review and the ICB has been discussing with providers the introduction of an annual report that reflects on feedback received from GPs and patients regarding their service and how they have used that feedback to improve their service offer.

9

The Board recommends that specific Key Performance Indicators (KPI) are included within the new contract to monitor and assess hearing aid maintenance and ensure regular reviews of hearing are undertaken.

The new service specification requires clinically led re-assessment and re-fitting to ensure hearing aids are fit for purpose, along with follow-up and annual reviews. A KPI has been added to require hearing aids to be repaired and returned to patients within 7 days, noting that hearing aids can mostly be maintained and/or repaired on site, but where they need to be returned to the manufacturer for repair, time is allowed for transit as well as the repair itself.

10

The Board recommends that NHS Sussex develops digital and non-digital patient communications, including leaflets, that provide patients with information on areas including:

a) a summary overview of the hearing aid pathway;

b) the importance of hearing aid maintenance and where patients can access it;

c) that patients cannot mix provision and maintenance for their hearing aids;

d) signposting to other available support for living with hearing loss.

This suggestion is welcomed and development of this information has been added to the list of actions for the collaborative of community audiology providers once the contract has been mobilised.

11

The Board recommends that NHS Sussex works with the new provider to explore whether it could deliver a same day drop off and maintenance and repair service for hearing aids.

As above and reported to HOSC previously, maintenance and repair is mostly done on the same day as patients often drop-in to the service, but where a hearing aid needs to be returned to the manufacturer, time needs to be allowed for transit as well as the actual repair.

12

The Board recommends that patients are automatically recalled for a hearing assessment on a regular basis and when they are due to receive a new hearing aid.

The approach taken in the service specification follows the national principle of patient-initiated follow-up whereby patients are seen in the service where they have indicated they need advice, after care, maintenance for their hearing aid or possibly another hearing assessment and new hearing aid with a higher spec due to a deterioration in their hearing. As previously reported, the service specification has moved away from the previous 3-year pathway in recognition of improved technology so there is now no set period within which a hearing aid should be replaced.

13

The Board recommends that NHS Sussex continue to work with relevant commissioners in ESCC Adult Social Care as part of contract implementation and ongoing monitoring.

A colleague from ESCC Adult Social Care was a member of the procurement project team and informed the service specification development and helped to formulate the relevant Invitation To Tender questions. They were a welcome and much valued member of the project team and reflect the integrated approach that will be a feature going forward of the delivery and ongoing improvement of this service.

14

The Board recommends that NHS Sussex works with Public Health to validate assumptions of future demand for the new age-related hearing loss contract.

On receipt of the needs assessment undertaken by ESCC Public Health colleagues for HOSC, we made contact with the Consultant in Public Health and sense-checked the ICB approach to modelling future demand, which was very helpful.

15

The Board recommends that NHS Sussex work with Healthwatch East Sussex and other patient representative groups to monitor the new contract to ensure it meets the specific needs of the population of East Sussex.

The accreditation prioritised accessibility, including considerations of language, mobility, and cultural needs, to ensure that every patient can receive the support they need in a way that is tailored to their individual circumstances. The updated service specification also focuses on improving patient access to audiology services for individuals with disabilities or additional health needs.

The ICB patient experience team works closely with Healthwatch across Sussex to ensure a timely response to feedback shared regarding services, including community audiology. Patient experience is also a golden thread of the KPIs and is discussed at every contract review meeting.

16

The Board recommends that NHS Sussex carefully evaluates the impact a single provider model has on the availability and provision of hearing aid services to the population of East Sussex and ensures it provides high quality continuity of care for existing patients.

Following feedback from HOSC and other stakeholders, the procurement strategy was amended in April 2025 to facilitate a multi-provider model. This will help to maintain continuity of care with incumbent providers, where providers have continued, and has opened up opportunities for other providers to help ensure good geographical coverage for rural parts of Sussex. e.g. Audiological Science are establishing a presence in Rye and Heathfield, as well as Hastings, Eastbourne, Peacehaven and Lewes (see Annex A).