National System of Care for Children and
Young people with Hearing Impairment
The next steps in Building the System
for
NE London
Barts Health PAWG
Eddie Herter
Waheeda Pagarkar
Ratna Shah
Jo Page
Margaret Baldwin
Watkin PM
September 2014
… joining up all audiology services for 5 districts
Waltham Forest
Redbridge
City and Hackney
Tower Hamlets
Newham
… joining up all audiology services for 5 districts – 400,273 0-19 yr olds
Waltham Forest
76,261
Redbridge
68,981
City and Hackney
79,682
Tower Hamlets
74,485
Newham
100,864
… joining up all audiology services for 7 districts – 499,358 0-19 yr olds
Waltham Forest
76,261
City and Hackney
79,682
Tower Hamlets
74,485
Redbridge
68,981
Barking, Dagenham
and Havering
99,079
Newham
100,864
… joining up
all audiology services
Redbridge
Waltham Forest.
• WXH sites- 3rd Tier
rd
• WXH sites- 3 Tier ENT Acute Surgical
• 2nd Tier – None
nd
• 2 Tier – None • Whipps Cross
ENT Acute Surgical
• School Nurse Screen by
• School Nurse Screen byUniversity Hospital
• Homerton University
NEL Foundation Trust
NEL Foundation Trust
Hospital
+ Education
City and Hackney
• Waltham Forest
• Hackney Ark-3rd Tier
• Redbridge
• Hackney Ark + John
• Newham
Scott HC – 2nd Tier
• Hackney
• School Nurse Screen by
• Tower Hamlets
Homerton UH Trust
• Barking and Dagenham
Tower Hamlets
• Havering
Newham
rd Tier
•
Hackney
Ark3
ENT Acute Surgical
• West Ham Lane-3rd Tier
Royal London + Steels
nd Tier
• Royal London•Teaching
Surgical
• WestENT
HamAcute
Lane-2
nd
Lane HC-2 Tier
Hospital
• Newham
General
• School
Nurse Screen
by
• School Nurse Screen by
University Trust
Hospital
EL Foundation
Barts Health
… joining up
all audiology services through commissioning
Local CCGs Waltham Forest, Tower
Hamlets , Newham , Barking and
Dagenham , and Redbridge , NHS
England, Barts Health and other local
providers have established a clinical
transformation programme called
Transforming Services, Changing Lives.
A key element of the programme
will be to consider how best to ensure
safe, effective and sustainable hospital
services at Bart's Health and Homerton
hospitals, set in the context of local
plans to further develop
and improve primary, community and
integrated care services.
… joining up
•
•
•
•
all audiology services through commissioning
What does good look like
What is working well
What is not working well
What are the constraints
commissioner support
to implement the National System
for an integrated NELondon
Audiology System
… the plan to join up
all audiology services
NDCS
The National System of Care
for
Children and Young People
with Hearing Impairment
CHSWG
North East London
Parents
Health +
Wellbeing
Boards
i. Council
ii. Health watch
iii. CCG
iv. Children Services
v. Public Health
vi. Social Services
… the plan to join up
all audiology services
http://www.healthcarepublichealth.net/
The National System for Children and Young People with Hearing Impairment
Public Health England can be rightly proud of the newborn hearing screening programme that it is responsible
for, and it was deemed one of the fifty top achievements of the last decade. However children with permanent
hearing impairment and their families face many problems that could be met better within present resource limits.
At present there are about 250 audiological and community services run by hospital and community trusts but
there is agreement that many of them offer poor quality of care. A report commissioned by the Department of
Health in 2012 and published in 2013 (available from National Programmes in the Healthcare website) describes
the design and delivery of a national system. A system is a set of activities with a common set of objectives. The
national system should be the same throughout England but the population will be covered by a number of local
systems working together. The local service configurations may differ depending upon history, tradition and
circumstance, but they will have common objectives with the same criteria enabling performance comparison
against the same set of standards.
The Scope of the System - The system is designed for children and young people in England with all degrees of
hearing impairment up to the point of transition to adulthood and adult services (which should occur before the
age of 25). All stages in the management of children and young people with hearing impairment and support for
their parents should be included: screening, assessment, differential diagnostics, and all aspects of subsequent
management including education and social support. This also includes temporary or recurrent episodes of
temporary, hearing impairment, unilateral, conductive hearing losses and other specialised paediatric
audiological services such as auditory processing disorders, auditory neuropathy/spectrum disorder, and children
with complex needs. It does not include paediatric balance disorders, which should be separately covered.
The Population Served - The system covers the whole population of England with care being delivered through
local systems which have an annual birth rate of between15-30K.
The Aim - is to enable children and young people to fulfil their social, emotional, communicative and educational
potential, by maximising their use of auditory sensory information. Central to this is the facilitation of confident
communication. The importance of non-speech environmental sound awareness is also acknowledged, as are
the needs of sign language users.
The Objectives
1. To identify children and young people with hearing impairment through screening and other pathways as
early as possible.
2. To confirm the nature and degree of hearing impairment accurately and quickly.
3. To provide effective medical and surgical assessment and management of hearing impairment and
appropriate technical assistance including implantable devices.
4. To prevent preventable permanent hearing impairment.
5. To provide integrated multidisciplinary cross-organisational support.
6. To provide support and information to the child or young person and their family and support them through
transition to adult services.
7. To enable each child to develop effective communication skills.
8. To develop the skills of all staff involved with children and young people with hearing impairment.
9. To mitigate inequity.
10. To make the best use of resources.
11. To promote and support research and the adoption of innovation.
12. To provide an annual report to the population served by the system.
Criteria have been set for these objectives with Levels of Performance identified to set Quality Standards.
The Partners
Services for children with permanent hearing impairment and their families require joined up working across
different health care providers and agencies. Central to this is an effective partnership between local health and
education services. Effective health care relationships with Child Health, ENT, School Nursing, Paediatric and
Maternity services are also required with delivery to a single local population by different providers. These service
and agency interdependencies are included in the unified local report of performance against common standards.
The Report
The common set of objectives, criteria and levels of performance for the local system will be reported annually to
enable performance comparison and to provide a process of accountability and continuous quality improvement.
Comparison of local systems requires collation of annual reports by a central organisation (eg NDCS)
Local accountability and quality improvement of different local health providers and their joint working with
education will be through annual reporting to Health and Wellbeing Boards set up to facilitate the joining up of
NHS services and local councils and the integration of care that is required by hearing impaired children.
Health +
Wellbeing
Boards
i. Council
ii. Health watch
iii. CCG
iv. Children Services
v. Public Health
vi. Social Services
… the plan to join up
all audiology services
The National System of Care
for
Children and Young People
with Hearing Impairment
North East London
DRAFT REPORT
SEPTEMBER 2014
Health +
Wellbeing
Boards
i. Council
ii. Health watch
iii. CCG
iv. Children Services
v. Public Health
vi. Social Services
… the report to the H+W Board
BY?
WHAT?
BY?
NHS CCG
Identification of
Deafness
eSP and SMaRT
Access to accurate
diagnosis
Clinical Reporting
System
Paediatric Audiology
Provider
The provision of
clinical care
Borough
The provision of
integrated support
Shared register
updated
from eSP and SMaRT
… the report to the H+W Board
The National System of Care
for
Children and Young People
with Hearing Impairment
North East London
DRAFT REPORT
SEPTEMBER 2014
Accessible, Readable and
Interesting and Contains………
i. Scored Performance Statements
ii. Tabulated Performance
measures
iii. Epidemiology report
iv. Action plan
The provision of clinical care
… action plan to the H+W Board
The National System of Care
for
Children and Young People
with Hearing Impairment
The NHS in East London has to meet the needs of some of the most
deprived areas in the UK and providing care for children and young
people with hearing impairment today whilst planning for tomorrow
requires the availability of robust local evidence on the epidemiology of
hearing loss. To achieve the best outcome for every hearing impaired
child they must receive the best clinical care delivered by high quality
medical and surgical services. The most beneficial amplification must
be available to them – including when required early access to
implantable devices.
For children with persistent or permanent childhood hearing impairment
(PCHI) by Provider Paediatric Audiology Clinic(s)
All parents of babies and children with a confirmed PCHI are offered referral to appropriate medical
consultants for aetiological investigation and assessment in a timely fashion – evidence based or informed
by professional guidance
All appropriate cases are offered hearing aid fitting within 4 weeks of confirmation of hearing loss unless
delayed for management reasons - measured by the NAS12 Performance Indicator
North East London
DRAFT REPORT
SEPTEMBER 2014
Appropriate hearing aids are fitted according to MCHAS or other accepted professional guidelines and
programmed with appropriate features using real ear measures and prescriptive fitting rules.
Robust on-going audiological care is proactively provided throughout childhood including regular checking
and replacement of hearing aids, hearing aid settings, and use in the home is carried out. This information
is shared with colleagues to form part of the child’s integrated support and audiology care plan.
*A hearing aid repair, ear-mould replacement and battery issuing service is available and accessible to
parents and other professionals each working day throughout the year
Hearing aids, listening systems and other devices have been purchased through a regularly audited joint
procurement system
90% of profoundly deaf children identified by the NHSP whose parents wish for implantation are implanted
before 12 month - measured by the NAS13 Performance Indicator
Promote awareness of and raise awareness among healthcare professionals of the preventable causes of
hearing impairment with information available in all healthcare settings
Provide robust evidence to support the epidemiology of hearing loss with the aim of reducing the number of
children with preventable hearing impairment per 1000 births
WXH
Paedi
atric
Sites
… action plan to the H+W Board
Improving Identification
The National System of Care
for
Children and Young People
with Hearing Impairment
North East London
DRAFT REPORT
SEPTEMBER 2014
• Whilst the Neonatal screen is
undertaken to an approved national
standard and routinely reports validity
data – this is not the case for the
School Entry Screen. The possible
movement of school nursing services
to Public Health and the availability of
a
designed
screen
reporting
programme (SMaRT) provides an
opportunity for Audiology to work
with the school nursing services and
Public Health to reverse this situation.
… action plan to the H+W Board
Improving Diagnostic Services

The National System of Care
for
Children and Young People
with Hearing Impairment
North East London
DRAFT REPORT
SEPTEMBER 2014

The IT systems are not yet in place to
report all the measures required to
assess the level of performance of this
System component. Performance
reporting can be built into the Clinical
Reporting System.
Not all the standards have yet been
agreed eg the performance measure
to evaluate the implementation of an
appropriate system of “Watchful
Waiting” and national rather than
local measures should preferably be
employed.
… action plan to the H+W Board
The National System of Care
for
Children and Young People
with Hearing Impairment
North East London
DRAFT REPORT
SEPTEMBER 2014
Improving Clinical Care
• Measuring the performance of our
Clinical Care requires the further
development of the integrated register
of PCHI with data imported from eSP
and SMaRT. This should also be the
basis of the annual epidemiological
report made to Public Health. In
addition it is clear that we are not
achieving the target for Cochlear
Implantation in infancy. Evidence
should be made available from the
register with improvement targets set.
The integrated register should also
enable co-ordination of clinical
activities with the educational service.
… action plan to the H+W Board
The National System of Care
for
Children and Young People
with Hearing Impairment
North East London
DRAFT REPORT
SEPTEMBER 2014
Improving Integrated Support

Although the Local Offer has been coproduced in some of the NE London
boroughs, an agreement (with terms
of reference) has not been coproduced between local Education
Services and the Audiology Service
detailing how service providers will
give integrated support to deaf
children and their families is required.
There is now an agreement with local
Audiology Services that there will be
an integrated agreement produced
and available for Children’s Services in
both boroughs.
and to follow………………….