Agenda item

6.1 The Committee considered a report from NHS Sussex providing an overview of audiology services in East Sussex, including an outline of pathways, barriers to accessing audiology services and how services were commissioned including whether there were any commissioning gaps. The report also outlined future commissioning plans, noting the fragility of the provider market, and that NHS Sussex was seeking to implement a new model from July 2025.

6.2 The Committee noted that current audiology pathways were confusing to patients asked how this was being addressed.

Wendy Young, NHS Sussex Director of Acute Services Commissioning and Transformation, accepted that the pathways could be confusing for patients, as the Any Qualified Provider (AQP) contract model resulted in there being number providers. As part of the future commissioning of the service NHS Sussex aimed to make access to information and services much simpler, which would likely move away from the AQP model and to a single-Sussex model that would provide patients with a single point of entry for accessing the service.

6.3 The Committee raised concerns that there were insufficient levels of provision in some areas of the county, especially rural ones, and asked for comment.

6.4 Wendy Young noted that the current AQP model made it difficult to ensure there was sufficient coverage in areas with lower population density, because providers were paid based on activity, which made it more cost effective for them to be based in more densely populated areas. Wendy also noted that there was good coverage across East Sussex, but this could be improved under the new commissioning approach.

6.5 The Committee noted that in some cases people were being directed to private services where their GP practice did not provide earwax removal services and asked for explanation.

6.6 Wendy Young responded that the expectation of locally commissioned services was that if a particular practice did not offer earwax removal, then there should be an inter-practice referral to another practice that does offer it. There were ten practices in East Sussex that did not offer the service which should be offering inter-practice referral, and Wendy agreed to check that this was happening.

6.7 The Committee asked what services were available for people in domiciliary and care home settings.

6.8 Wendy Young explained there was a domiciliary service for patients unable to travel to appointments and this would continue under new commissioning arrangements. Wendy agreed to share the detail of the provision and criteria for access outside the meeting.

6.9 The Committee asked for detail on what the expected new commissioning model would look like.

6.10     Wendy Young responded that consideration was being given to a number of different commissioning models, noting that the AQP model incentivises providers to base themselves where they get the highest footfall and therefore highest income. It would most likely move towards a single-Sussex primary provider model, which would enable NHS Sussex to have more influence on the location of provider sites and ensure better access for patients.

6.11     The Committee noted that better access was hugely important, and an understanding of where the current gaps in provision were should inform future commissioning. It therefore asked that information be provided on which specific audiology services were provided at each GP practice in the county. Wendy Young agreed to share the information requested outside of the meeting.

6.12     The Committee asked about access for those on lower incomes, noting that some people were being signposted to private providers, but could not afford those services.

6.13     Wendy Young answered that practices should not be signposting for earwax removal services to private providers. NHS funded ear irrigation and microsuction services were available and agreed to confirm that practices which did not provide those services were signposting to NHS-funded services.

6.14     The Committee asked for confirmation on whether microsuction was the safest means for earwax removal and why it was not more widely offered.

6.15     Wendy Young answered that the NHS Sussex three-tiered pathway of self-care first, followed by ear irrigation, followed by microsuction, followed National Institute for Health and Care Excellence (NICE) guidance.

6.16     The Committee noted that Hastings had fewer primary care providers than other parts of the county, and asked what plans were in place to support access and improvement to audiology services in Hastings.

6.17     Wendy Young responded that audiology services were provided in Hastings, and agreed to share information on current volumes of activity and locations of services in the borough. If there were issues with access to services via the locally commissioned service then Wendy agreed to investigate these further.

6.18     The Committee asked that NHS Sussex further consider how to improve communications to residents about availability and access to audiology services, especially in more deprived areas.

6.19     Wendy Young agreed further consideration would be given to this, in particular to ensure people understood that NHS funded services were available and that people did not need to seek private provision if they did not wish to.

6.20     The Committee noted that in areas with high GP wait times patients were more likely to feel compelled to access private services, and asked how this was being addressed.

6.21     Wendy Young answered that consideration could be given to pathways that would allow patients to self-refer for audiology services, as access to a GP could be a limiting factor for some patients. Wendy agreed to consider whether self-referral could be built into the pathways as part of the future service specification.

6.22     The Committee asked why a significant proportion of people surveyed [by Healthwatch] went to private providers for earwax removal if there was sufficient NHS provision.

6.23     Wendy Young responded that communication of what services were available was important, and that there was an issue in primary care about patients being signposted to NHS funded services if their practice could not offer earwax removal. Private sector provision was often easier for people to access, and there was a need for improvement to messaging and signposting.

6.24     The Committee asked what monitoring and regulation of private sector providers there was.

6.25     Wendy Young responded that if NHS Sussex did not commission a service, then it did not have oversight of them. All healthcare providers should still be registered and have Care Quality Commission (CQC) regulation. Wendy agreed to provide further clarification outside of the meeting.

6.26     The Committee asked where the new provider, The Outside Clinic, was based.

6.27     Wendy Young agreed to provide information of where the provider came from outside of the meeting. Even if it was not a local organisation it could still provide a local service within the county to NHS standards.

6.28     The Committee commented that its view was that the audiology services in East Sussex did not appear to be provided consistently or as intended, and was insufficient in some areas. It agreed to establish a Review Board of the Committee to explore the issue further and make recommendations about future service provision. Wendy Young and Ashley Scarff, Director of Joint Commissioning and Integrated Care Team Development (East Sussex) accepted that there were issues with the service and welcomed the opportunity to work closely with HOSC to improve these.

6.29     The Committee RESOLVED to:

1)    note the report from NHS Sussex; and

2)    carry out a review of the provision of audiology services in East Sussex.