Kingdon review of children’s hearing services: final report

Following the transition of DHSC and NHS England to one organisation (hereafter called ‘the new organisation ( DHSC and NHS England)’), the new organisation ( DHSC and NHS England) should consider how to best continue the Paediatric Hearing Services Improvement Programme ( PHSIP ). Based on the findings of this review, the most effective responses have been by strong regional teams. Regional teams must be enabled to use local incident response processes with very clear timelines for completing all follow-up assessments and discharge and or placement on a treatment pathway where required. The central programme team should be suitably funded and resourced and fulfil the role of supporting regional teams. The name and terms of reference of the programme should be revised to more accurately reflect its focus on review and recall of children affected by service issues.

The new organisation ( DHSC and NHS England) should use the new service frameworks proposed in the 10 Year Health Plan to drive improvement and innovation by defining the goals for the care pathway in children’s hearing services, setting standards and supporting the workforce to deliver these goals. The new organisation ( DHSC and NHS England) should develop a model commissioning contract for ICBs to use for children’s hearing services. This should include key performance indicators ( KPIs ) relating to safety, effectiveness and patient experience. This contract should ensure services can protect ringfenced time for clinical audit, quality assurance and CPD activities. This approach has the potential to act as a template for other similar services. All ICBs should support their children’s hearing services to become IQIPS accredited and identify capital funding to improve audiology testing equipment where needed in order to facilitate that process.

The new organisation ( DHSC and NHS England) should work with the organisations which represent audiologists and with NHS trusts to require all audiologists to be registered on a single professional register, which is operated by an appropriate body on a non-statutory basis. The numerous organisations representing professionals in audiology should merge to create a single body responsible for engagement with national institutions and development of appropriate guidance, training and curricula for audiologists. This body should play a role in developing and maintaining a single professional register of audiologists. The new organisation ( DHSC and NHS England) should establish clear policy responsibility for healthcare sciences, including audiology, and publish a charter setting out expectations on both sides for engagement between the relevant organisations representing professionals in audiology and the new organisation ( DHSC and NHS England).

The new organisation ( DHSC and NHS England) should work with ICBs to redesign the delivery model for children’s hearing services, creating networks which facilitate robust clinical supervision and peer review. The example of child safeguarding networks should be considered during the design process. The new organisation ( DHSC and NHS England) should work with ICBs to ensure services are of sufficient size that staff members can rotate and observe others in their clinical practice on a regular basis. Any unsafe services should be closed and service provision reallocated.

Every NHS trust should appoint a lead healthcare scientist who is responsible for reviewing KPIs across healthcare science professions, including audiology. This individual should be responsible for managing risks and issues in the relevant services and be required to report to the Trust Board at least twice a year. Every ICB should have access to healthcare science expertise to support effective service commissioning. Every NHS regional team should retain a regional healthcare scientist and ensure they have adequate training and support to manage risks and issues across all healthcare sciences, including managing incident response processes when needed.

The new organisation ( DHSC and NHS England) should act to implement the recommendations of the recent Review of patient safety across the health and care landscape immediately and reform the role of the National Quality Board. The new organisation ( DHSC and NHS England) should identify a number of KPIs to measure the performance of children’s hearing services and require ICBs and/or NHS trusts to report against these and publish them annually. NHS trusts and ICBs should put in place robust data analysis and governance arrangements to review these KPIs and address any issues arising on a regular basis as part of their quality management systems. The new organisation ( DHSC and NHS England) should issue and publish the results of a benchmarking survey into the provision of different treatment options (in particular different types of hearing aids and eligibility criteria for cochlear implants) for deaf children across England and work with the National Institute for Health and Care Excellence ( NICE ) to issue updated relevant guidance to help standardise care.

The organisation responsible for maintaining the single professional register for audiologists should require all its members to undertake regular CPD , funded by their NHS trust. The new organisation ( DHSC and NHS England) should commission the National School of Healthcare Science to redesign the undergraduate and postgraduate training pathways and funding arrangements for audiology to ensure sufficient training in paediatric speciality for paediatric audiologists, develop standards for the curriculum and independent assessment of diagnostic testing ability. The new organisation ( DHSC and NHS England) should commission work to develop appropriate CPD training modules for audiologists, including on quality assurance and safety standards in children’s hearing services. This should include the involvement the National School of Healthcare Science and the organisations representing professionals in audiology.

National research funding bodies should encourage research to realise the potential offered by machine learning, data analysis and other technologies in children’s hearing services.

All children’s hearing services and all audiologists should be setting the standard for deaf awareness and should have access to regular training on how to ensure they can meet the communication needs of their patients. All children’s hearing services should seek feedback from service users, and ensure systems are in place for patients, parents and carers to provide feedback in a timely manner, with reassurance that the feedback is welcome and will help to improve care provided. These processes must be accessible to all users.

The new organisation ( DHSC and NHS England) should change the way workforce data is collected and coded to enable posts in all healthcare sciences, including audiology, to be identified by seniority, speciality and setting and enable effective workforce planning. The new organisation ( DHSC and NHS England) should adapt the NHS Staff Survey workforce codes so that responses from healthcare scientists can be identified by speciality (for example, audiology) for separate analysis, ensuring this would not compromise the anonymity of individual staff members in small services. The successor or successors to the National Guardian’s Office should complete and publish a review into workplace culture in children’s hearing services and provide recommendations for measures to support the workforce. This should include consideration of whistleblowing, bullying, stress-related illness and stress-related early retirement in children’s hearing services.

The new organisation ( DHSC and NHS England) must establish arrangements and responsibilities for a regional incident response process. This process would set out the approach for managing widespread patient safety and quality incidents that are serious but do not meet the threshold of a national incident, in order to provide standardised responses, including leadership, risk management, escalation routes, staffing resourcing and funding. The new organisation ( DHSC and NHS England) must ensure proactive communication to the public and to affected patients is planned at an early stage when widespread patient safety or quality concerns are established, in line with the approach taken in policy areas such as screening. The new organisation ( DHSC and NHS England) should create a ‘special projects team’ to investigate quality and safety concerns in specific areas of the health system and make recommendations for improvement before handing over to ‘business as usual’ ( BAU ) policy teams or incident response processes.

As part of the transformation programme which will create a new organisation out of DHSC and NHS England, specific training and guidance should be provided for all those transitioning to a civil servant role regarding when and how ministers should be sighted on safety or quality issues and regarding expectations for working with ministers.