Paediatric Audiology - FOI Response Register

2023-474

Paediatric Audiology

09/11/2023

Paediatric audiology services survey 2023

The information requested may relate to services which are held in more than one department e.g. ENT services. As you remain legally accountable for these services, we still expect you to collate the information, rather than referring us on.

This is part of a UK-wide request, using a standardised format, nationally tailored, to ensure consistency. Please use the box at the end of this survey to provide any context or background to any of your answers.

Questions for paediatric audiology services: 2023

Please only complete this survey if your service provides audiological services to children and young people. This may include diagnostic hearing assessments and monitoring of hearing, hearing aid provision, and ongoing audiological management of deaf children, (and may include assessment and management of other audiological conditions). This may be hospital or community based.

It is not necessary to complete this survey if your audiology service only provides hearing screening, e.g. newborn hearing screening or school screening and refers children on to other services for full assessment and hearing aid provision when necessary.

Please base your answers on the service provided as of 30 September 2023.

Section 1: About your service

Please answer the questions below based on the situation as of 30 September 2023.

Please provide the following information:

Name of person completing survey	In accordance with FOISA s 17(1), NHS Shetland confirms that it does not hold the information requested.
Your role	See above response
Your email address	See above response
Your telephone number	See above response
Name of your audiology service	Audiology Service

If you are commissioned to provide an audiology service for another Board/s please provide details of all the Boards that you provide services for below. Please write names in full and expand acronyms.

No

If you provide services for another Board/s, do these include diagnostic hearing assessments and hearing aid provision for children in any of these locations? Yes/no

If you would like to report separately for a service you deliver for another Board, please contact us on Listenup@ndcs.org.uk for an additional link.

Please complete the table below showing the locations where your Board provides paediatric audiology services:

Name of Health Board

Hospital or Clinic or site name

Address

Postcode

Is your service jointly delivered with an adult service? (for example, does the service share clinical staff/a reception/ waiting area/share a budget/ other?)

Please state which:

See response to Q2

Section 2: Your caseload

How many deaf children are there within your case load? If you are not sure, please estimate.

	On 30 September 2023
Number of births per annum your service covers	In accordance with FOISA s 17(1), NHS Shetland confirms that it does not hold the information requested.
Total number of children with permanent deafness (PCHI) on your caseload as of 30 September 2023 - see definition below *	0
Of this total, how many of the children with PCHI were identified via referral from the Newborn Hearing Screen from 1 October 2022 to 30 September 2023	See response to Q1 (ii)
Of this total, how many of the children with PCHI were identified via other referral routes e.g. referral from GP, HV, school screen etc. from 1 October 2022 to 30 September 2023	See response to Q1 (ii)

PCHI should include:

All children who have a permanent sensorineural or permanent conductive deafness (unilateral or bilateral), at all levels from mild to profound.
Those with permanent conductive deafness to include those children with a syndrome known to include permanent conductive deafness, such as microtia/atresia, middle ear malformation, or those who have had middle ear surgery such as mastoidectomy.
Please do NOT include children known to have Auditory Neuropathy Spectrum Disorder (ANSD) here as PCHI.

What age group does your service cover? Select one.

Age
0 - 16
0 - 18	None of these apply. Our service covers 4-18 as part of general Audiology Service. No specific Paediatric service.
0 – 18 and also specific groups of young adults such as those in full time education or with additional support needs

Section 3: What services do you provide?

Please answer the questions in this section based on the situation as of 30 September 2023.

What options do you have for assessing the hearing of complex/difficult to test children?

	Do you offer this option?	If yes, what specific training and protocols do you have for this option?
Specific clinics e.g. with longer clinic times/more experienced staff 2-staff VRA clinics, single staff clinics. Time typically is longer than standard, but staff have the option to adjust timings in the event they believe it necessary.	No
Use of non-calibrated stimuli (e.g. non-calibrated, but band-pass filtered music)	No
Sedated ABR	No
ABR under anaesthetic	No
Other, please specify	No

Comments- please use this space to provide any additional information.

These services are provided to Shetland residents by NHS Grampian.

What options are included in the current management pathway in your service for temporary conductive hearing loss?

	Do you offer this option?	What alternative do you offer if a child is on the waiting list?
Air conduction hearing aids	No – patients go to NHS Grampian for treatment	X
Bone conduction hearing aids	No – patients go to NHS Grampian for treatment	X
‘Watch and wait’	No – patients go to NHS Grampian for treatment	X
Grommets	No – patients go to NHS Grampian for treatment	What alternative do you offer if a child is on the waiting list?
Otovent	No – patients go to NHS Grampian for treatment	X
Other, please specify		X

Do you provide hearing aids for the following groups of children? If you do not provide hearing aids for these groups, please explain why.

Group of children	Do you provide hearing aids for this group?	If no, please explain why hearing instruments are not provided to this group or are only provided in certain circumstances (for example, only moderate UHL or bilateral ANSD.)
Temporary conductive loss	No	No – patients go to NHS Grampian for treatment
Unilateral loss	Yes
Mild loss	Yes
Moderate loss	Yes
	Yes
Other, please specify

Section 4: Accessibility

Please answer the questions in this section based on the situation as of 30 September 2023.

Which of the following forms of communication are available to patients for making bookings and enquiries?

	Do you offer this option?	What is your target service response time?	What is your actual service response time?	Is anything preventing you from reaching your target?
Email	Yes	2 days	2 days	No
Text message	Yes	2 days	2 days	No
Web form	No
Online diary/booking system	No
Telephone	Yes	2 days	2 days	No
British Sign Language	No
Other, please specify

What deaf awareness training does your staff have?

	One off training	Regular updates
Audiologists		Yes
Reception/administrative staff	Yes

Do any of the staff in your service use BSL to interact with patients?

Audiologists	No
Reception/administrative staff	No

Section 5: Waiting times

In the last year (1 October 2022 to 30 September 2023) how many days on average did patients wait for the following? If you are not sure, please estimate.

We understand that waiting times are difficult in every area at the moment and services are working hard to clear backlogs. Data provided will be analysed with these considerations in mind and will help us to understand where services may be struggling.

	Number of days
Referral to first diagnostic assessment from the newborn hearing screening pathway	N/A not understaken in NHS Shetland
Referral to first diagnostic assessment for those not referred from the newborn hearing screening pathway	55 days

If you would like to add any information about your service and the data provided on waiting times, please use the free text box below.

Section 6: Quality assurance and improvement

What methods do you use for quality assurance and improvement? Select all that apply.

A local programme of audit against national quality standards	Yes
IQIPS accreditation	No
Internal peer review (ABR)	n/a
Internal peer review (behavioural testing)	Yes
Internal peer review (HA fitting)	Yes
External peer review (other than ABR – this will be asked below)	No
Case studies/journal clubs	Yes
Regional network to share best practice	Yes
Reporting all PCHIs on SMART 4 Hearing	No
Audit cycle	Yes
Peer competency checks	No
Patient/service user surveys/focus groups	Yes
Other, please specify

Do you participate actively in external regional peer review for ABR?

No, no ABR service provided in Shetland

If yes, complete the table below. If no, please explain why -

Do you regularly submit traces of all hearing losses and a sample of discharge?	How do you act on the evidence you receive?	How many ABR testers are in your service?	How many of the ABR testers in your service actively take part in peer review?

Section 7: Staffing and training

How many substantive full-time equivalent (FTE) qualified audiologists are in your service in total?

0.56 wte

How many FTE clinical staff does your children’s audiology service have at the following levels as of 30 September 2023?

Please express part-time roles as a fraction of a full-time role e.g. one full time role and a part time role of three days would be 1.6 FTE.

If a role is split between children’s and adult’s audiology services, please assign (or estimate) an FTE figure to the time spent working with children.

(We understand that staff may cover paediatric ENT clinics as well as audiology’s own clinics, but we are interested in changes in staffing levels year on year.)

Level	Total number of substantive posts (FTE)	Of the total number of posts (FTE), how many are vacant?
Band 2
Band 3	0.1	0
Band 4
Band 5
Band 6
Band 7
Band 8a	0.1	0
Band 8b
Band 8c
Band 8d
Band 9
Doctor (e.g. paediatrician, AVP)

Has there been a reduction in the number or skill level of staff compared to last year?

No

If decreased, what are the reasons for this? Select all that apply.

If no, please go to the next question.

Unable to recruit staff
Posts have been frozen or deleted
Staff leaving or reducing hours
Maternity leave or sick leave
Board decision or cost improvement plan
No capacity to train new staff
Other, please specify

Please use this space to provide more information about your responses above.

What steps have you taken to address any staffing issues? Please describe briefly.

N/A

Section 8: Collaboration section

Please answer the questions in this section based on the situation as of 30 September 2023.

Which children do you refer to the local specialist education service for deaf children in your area? Select all that apply.

	Aided children Yes, we refer these	Unaided children Yes, we refer these
Children with a severe/profound hearing loss	Yes	Yes
Children with a moderate sensorineural hearing loss	Yes	Yes
Children with a mild sensorineural hearing loss	Yes	Yes
Children with permanent or long-term conductive hearing loss	Yes	Yes
Children with temporary/fluctuating conductive hearing loss	Yes	Yes
Children with a hearing loss but who are unaided	Yes	Yes
Unilateral hearing loss	Yes	Yes
ANSD	Yes	Yes
Other
Don’t know

We recognise that education referral criteria are outside the remit of audiology services, but we are grateful for your help collecting this useful information.

If other, please provide more details.

Are you able to routinely refer directly to the following non-audiology/ external professionals?

	Yes/No	Which children do you refer?
Speech and language therapy	Yes	Any based on clinical referral criteria
ENT	Yes	Any based on clinical referral criteria
Family support/social Work department	Yes
Child Protection	Yes	Any based on clinical referral criteria
Clinical psychology/CAMHS	Yes	Any based on clinical referral criteria
Paediatrician/developmental assessment service	Yes	Any based on clinical referral criteria
National Deaf Children’s Society	No
Other third sector/community organisations	No

Are there any other services you refer to/struggle to refer to? Please comment.

No local third sector representation

Which families do you routinely signpost to the National Deaf Children’s Society? Select all that apply.

	Yes, we signpost these families	Routinely provide National Deaf Children’s Society information
Children with a severe/profound hearing loss	Yes	Yes
Children with a moderate sensorineural hearing loss	Yes	Yes
Children with a mild sensorineural hearing loss	Yes	Yes
Children with permanent or long-term conductive hearing loss	Yes	Yes
Children with temporary/fluctuating conductive hearing loss	Yes	Yes
Children with a hearing loss but who are unaided	Yes	Yes
Unilateral hearing loss	Yes	Yes
ANSD
Other
Don’t know

When do you signpost families to the National Deaf Children’s Society? Select all that apply.

	Yes, we signpost at these times
At diagnosis	Yes
Whenever a family has an issue that the National Deaf Children’s Society may be able to support	Yes
At every appointment	No

Section 9: Patient engagement

Please answer the questions in this section based on the situation as of 30 September 2023.

How do you prepare young people for transition to adult services? Select all that apply.

Start talking about the transition process from age 14
Completed a board transition assessment/process
Provide information on the adult service for young people
Hold joint appointments with both paediatric and adult audiologist present (virtual or face to face)
Offer an appointment with the adult service before being discharged from the children’s service
Offer young person the opportunity to come into the clinic without parent/carer if appropriate
Hold transition event or clinic for young people
Visit local schools to offer sessions to share information with young people about deafness, independence and transition etc.
Other, please specify	Yes- No transition locally as all provided by same Audiologist in same service

How many appointments were classed as Was not Brought (WNB) or Did Not Attend (DNA) in the period 1 October 2022 to 30 September 2023? If you are not sure, please estimate?

Please provide the total number of appointments offered in the period 1 October 2022 to 30 September 2023 (including all appointment types for children) and the WNB/DNA rate (%).

Total number of appointments offered in the period 1 October 2022 to 30 September 2023 (all appointment types for children)	Percentage WNB/DNA
50	12%

Please indicate which strategies are used to reduce missed appointments. Select all that apply.

Partial booking
Text reminders
Phone reminders	Yes
Other – please specify
None

Section 10: Issues affecting service provision

Are there any areas where demand has changed significantly in the last year?

	Has demand increased in this area?	Has demand decreased in this area?	What do you think has caused this?	What support would help you?
Routine pre-school assessments	No
Routine school aged assessments	No
Children requiring complex assessment techniques/multiple appointments	No
Children requiring sedated ABR/ABR under GA	No
Children with listening difficulties in the presence of normal hearing	No
Self-referrals	No
Referrals from school screen	No
Other, please specify

We are keen to promote and share good practice. Is there any good practice or an innovative solution in your service that you would like to share with us?

Are there any challenges to your service?

Challenges you are experiencing now	Challenges you anticipate in the future
No	No

Please use the box below to provide any context or clarification to any of your answers in this survey. Please also use this box if there is anything else you’d like to add.

N/A

Many thanks for returning this survey. We are very grateful for your time.