The National Audiology Review – is Scotland failing deaf children?

Mark Ballard outlines writes that it is time for the Scottish Government to act on the National Audiology Review

Serious failings in support for deaf children have been laid bare in the final report of the Independent Review of Audiology Services in Scotland. Mark Ballard outlines the history of the Review, and suggests that it is time for the Scottish Government to act on the recommendations of the report.

In 2018, parents raised concerns with the National Deaf Children’s Society about their experience of Lothian’s Children’s Audiology Services. This eventually led to a complaint being raised by a parent with the Scottish Public Services Ombudsman, who upheld it, and NHS Lothian agreed to carry out an urgent review of its services.

The British Academy of Audiology (BAA) was commissioned to carry out an audit of NHS Lothian’s paediatric audiology caseload from 2009-2018. This included nearly 23,000 children, of which the BAA sampled just over a thousand records. The results were damning.

The full findings were revealed in a report published in December 2021. Only 120 of the records the BAA examined raised no concerns at all. However, in 155 of the records, the concerns were “significant”, with some shocking stories of children’s deafness not being identified, of parents not being believed, and opportunities for medical intervention missed. It found that the average age of children identified as deaf under NHS Lothian was four and half years old, compared to just over three months, on average, in services in England. The report concluded that this massive discrepancy appeared to have gone “unreported and un-noticed.”

Some of those children suffered life-changing consequences: waiting years to be provided with hearing aids; being diagnosed too late to have vital hearing implant surgery, which would have allowed them access to sound; not having the chance to use sign language from an early age. The National Deaf Children’s Society continues to work with Families Failed by Lothian Audiology Action Group, to try to ensure that these children are not failed again by a lack of ongoing support.

Having worked with parents to expose the failings at NHS Lothian, and after considering the horrendous findings of that report, the National Deaf Children’s Society called on the Scottish Government to launch an urgent and sweeping review of children’s hearing departments across Scotland. The review ran for about a year from spring 2022 to spring 2023, with the final report and recommendations published in August 2023.

We are grateful that the Independent National Review was carried out, but the findings of the review show there are serious issues affecting audiology services across the country. Without urgent action, more deaf children will be failed.

The review found “multiple, systemic problems affecting audiology services in NHS Scotland”, including an “absence of national leadership, strategic planning and workforce planning” and that there had been “no quality assurance of services” in recent years.

A lack of consistent data collection across Scotland means it is difficult to monitor quality and compare how health boards are performing. The most alarming recommendations the review identified are around the auditory brainstem response (ABR) testing, carried out to identify deafness in very young children, and ensuring hearing aids are properly fitted. The review identified an urgent need for training to improve the quality of ABR testing at every health board in Scotland. We want to see urgent action to address this problem.

There is also cross-sector consensus that we must increase the number of  paediatric audiologists. Scotland urgently needs a graduate level audiology programme to help address the national shortage of audiologists, as well as a fast-track route into the profession for those other relevant qualifications.

We also know that morale amongst audiologists is at rock bottom, with workforce shortages, lack of training, and staff feeling that they are being pushed to do more with few resources, while feeling they are being blamed for a situation they cannot improve. Increasing numbers of audiologists are on long term sick leave with stress or opting to leave the profession completely.

We are still waiting for the response from the Scottish Government to the recommendations in the report, six years after concerns were raised about NHS Lothian, and nearly two years since the BAA report.

The bottom line is that there must be change. We know that deaf children can achieve anything that hearing children can when they get the right support, but for this to happen their deafness must be identified at the earliest opportunity and they must always receive high quality and effective support.

That’s why NDCS are calling on ministers to act now, to ensure parents can be certain their deaf child is receiving the support they need. Parents have a right to know that if there are concerns about their child’s hearing that they will have a specialist hearing test undertaken at the right time, carried out by an appropriately trained audiologist. Parents need to be reassured that the audiology department they rely on is properly staffed and has the equipment it needs. The Scottish Government and NHS boards know what they need to do. We hope the Scottish Parliament holds them to account on the delivery of the recommendations.

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