23 February 2011
NHS Hearing Aids - Free But at What Price?
In the UK we are fortunate enough to have a free provision of hearing aids by way of the NHS. Over the last few years, the NHS has switched from analogue to digital hearing aids for the majority of patients. These hearing instruments are of a reasonable quality and are programmed to match the patients hearing loss. Fantastic! I hear you say, but there's perhaps a little more to this situation than meets the eye.
In order for a hearing impaired person to achieve the maximum benefit from hearing instruments, there are several bases that need consideration:
Technology
Hearing aid manufacturers are producing fantastic new technology at an amazing rate. Unfortunately this technology takes a long time to reach the hands of the NHS audiologist. This is as a result of the processes involved in getting new hearing instruments made available the NHS. This is in no way a criticism of the NHS. I can appreciate that a huge organization such as the NHS requires time to evoke changes – especially if new technology is emerging thick and fast. New products require training for the audiologist to make the most of the new features. The manufacturers simply would not have the capacity to train an organization the size of the NHS on an on-going basis. The result is the hearing impaired NHS patient cannot receive the best technology available.
Cost
New technology hearing instruments typically carry a higher price tag. Hearing aid manufacturers are not charities and they need to recoup their research and development costs – and make a profit to keep their shareholders at bay.
Cosmetics
Many hearing impaired people put off getting hearing aids as there is still a stigma attached to wearing them. The ultimate motivation for them to do something is when their hearing loss becomes truly unbearable for them and their friends and family. If patients were offered more cosmetic solutions then they would be more likely to do something sooner rather than later. No matter how amazing the technology or how "free" it is makes little difference if someone simply won't the hearing aids. The NHS mainly offers standard behind-the-ear hearing aids with a quite noticeable plastic earpiece.
Reprogramming and fine tuning
Virtually all hearing aids available today, be they private or NHS, are digital and programmable. This means that the hearing aids can be reprogrammed to match the hearing loss as and when the hearing deteriorates. Unfortunately, the NHS simply do not have the capacity to retest, reprogram and fine tune hearing aids on an on-going basis. This service is one of the benefits of seeking a private hearing aid dispenser. This is perhaps the most important aspect of delivering the maximum benefit from wearing hearing aids which is sadly overlooked in the public sector.
The NHS in the UK is the largest single purchaser of hearing aids in the world – not just the UK. The price of private hearing aids in the UK is amongst the highest in the world. The 2 facts are intrinsically linked. Most people get their "free" NHS hearing aid and never go privately. The result is that the private market is shrunk. The private hearing aid retailers are therefore left fighting over a relatively small market. In order to attract these clients they need to invest heavily in marketing which results in the prices of the hearing aids being inflated. In other countries where there is little or no public provision, prices of private hearing aids are substantially lower.
So what is the solution? If we do away with a free provision then the poorer people may not be able to afford the hearing aids that they need. I don't believe this is an option. If we stay as we are then
a) The latest technology will be very expensive (as it is now) and will only be available to the select few.
b) Cosmetic solutions will remain out of the reach of most people.
c) On going fine tuning and rehabilitation will remain the domain of the private consumer.
In my opinion, the best solution would be to adopt a system used in other countries such as the Republic of Ireland. My recommendation would be to provide vouchers to every patient to redeem with a private hearing aid dispenser. The value should be that of the cost of fitting and maintaining a modest pair of hearing aids. If the patient wanted better technology then they could pay the difference. I have no doubt that the spare capacity currently within the private sector, added to the inevitable spare staff from the NHS would deliver more than enough service. The increased volume of private sales coupled with the reduced marketing costs would serve to drive down the costs of private hearing aids in the UK. This would enable more people to afford better technology. Everyone would benefit from on-going aftercare and free hearing instruments would still be available to those that wanted them. I understand that proposals like this have been put forward in the past. Sadly, I believe these suggestions fell on deaf ears.