Agenda item

Marcus Warnes will be carrying out a second presentation.  Copies to follow.  There is a time limit of 10 minutes to carry out presentations as per the Council’s Constitution

Members are requested, where possible, to submit any questions to Justine Tait before Friday 19 September 2014

The Chair welcomed Marcus Warnes, Chief Operating Officer from the North Staffordshire Clinical Commissioning Group and Dr John Harvey to the meeting.

Mr Warnes provided a presentation to the Committee in relation to hearing aid provision in North Staffordshire. Mr Warnes emphasised to the Committee that no decision had yet been made nor had any formal consultation been commenced. The CCG sought the views and recommendations of the Committee prior to reporting back to the Commissioning, Finance and Performance Committee on 15^th October and to the CCG Governing Board on 5^th November 2014.

Mr Warnes outlined the commissioning and prioritisation processes and how they were used to identify priorities to ensure that the best use could be made of NHS funds locally and which investments should be made to deliver the best outcomes for patients.

The prioritisation process was led by the Clinical Priorities Advisory Group (CPAG) which ranked interventions in order of clinical importance prior to reporting back to the CCG; interventions falling below a certain threshold were not considered for investment and those that were already commissioned were considered for decommissioning.

Mr Warnes also provided information regarding the engagement activities that had taken place regarding the hearing aid question and the results that had come from that engagement.

Concerns were expressed by Members and the following questions were raised and answers given:

1.  That, without a hearing aid, those with mild to moderate hearing loss could, in some cases, feel isolated and lose any sense of pride or achievement – how, therefore, was prevention of future illnesses given a zero rating in the CPAG?

Dr Harvey agreed that there was evidence to show that a link existed between an individual’s mental health and hearing loss but there was little or no evidence to show what impact a hearing aid would have on this.

2.  How had such a low rating been given to individuals with an existing health problem such as dementia or poor mental health?

Again Dr Harvey emphasised the point that it was recognised that there could be an impact on the quality of life for those individuals with mild or moderate hearing loss through having a hearing aid provided, but that it was relatively small to other ranked interventions for other conditions. An enhanced ability to hear did not necessarily reflect in an enhanced quality of life.

3.     Had studies not shown that hearing aids did, in fact, help increase the quality of life along with a magnitude of other health benefits?

Dr Harvey stated that he was not aware of any studies that had proven this. The CCG had reviewed a number of studies carried out in the USA by audiologists, which showed that those with more severe hearing loss benefited most from intervention and that the CCG had based its prioritisation on this scientific evidence.

4.     Was it surprising that a response to the engagement had been received from across the entire country?

Mr Warnes stated that this was not unexpected as there was a huge amount of interest nationally in the project, especially with North Staffs CCG being the first to go down this route. All CCGs were in the same situation with increasing demand for services and less money.

5.     Was the CCG prepared to see people paying thousands of pounds for a hearing aid?

Mr Warnes stated that hearing aids for mild to moderate hearing loss could be purchased from £349 up to £1500. The hearing aids for more severe hearing loss were more expensive (up to £3000) but these were not currently provided on the NHS, which only provided hearing aids that cost in the region of £400.

6.     Had the CCG considered making the NHS hearing aids available via means testing?

Mr Warnes stated that yes there were three possible options – fully decommission, fully fund or a solution somewhere in the middle.

7.     Had the CCG taken note that every professional in the field has objected to the proposals

The CCG was fully aware of this but highlighted the fact that all the responses received had come from those in the field (hearing aid users or audiologists) and that this still needed to be balanced against all other priorities and the CCG had the very hard job of trying to compare these priorities.

8.     If those with mild to moderate hearing loss are not supported now would not this just lead to greater problems and more cost in the future, including mental health issues that could be exacerbated or caused?

Dr Harvey agreed that there could be progression and that this would be built in to any eligibility criteria. It was fully recognised that those with mental health concerns needed to be able to communicate as clearly as possible.

9.     Would there be a full consultation process following this engagement exercise?

Yes, the engagement process was to help shape the actual proposal that could then be consulted upon. Mr Warnes was also fully aware that neither the County Council Healthy Staffordshire Select Committee nor Staffordshire Moorlands Health Scrutiny Committee were supportive of the current proposal.

Members also questioned whether the Better Care Fund could be used to fund the provision of hearing aids but it was advised that this money was not new money and that money going into the BCF was currently being spent on services and that if it was to be spent on hearing aids then cuts would still have to be made elsewhere.

The motion was put forward that the Committee state that it was unable to support the current proposals and that this be fed back to the CCGs Commissioning, Finance and Performance Committee.

This was seconded and all were in agreement.

Resolved:     That the Newcastle under Lyme Health and Wellbeing Scrutiny Committee do not support the current proposals put forward by North Staffordshire CCG in relation to hearing aid provision in North Staffordshire.