BSHAA NEWS December

BSHAA News British Society of Hearing Aid Audiologists An essential update for all those with an interest in audiology

www.bshaa.com

WINTER 2010

BSHAA AGM 2010: full report page 19

inside

BSHAA News is published quarterly and issued FOC to all BSHAA members and so offers significant access to the vast majority of those involved in the private hearing aid sector.

Editor: Ian Croft | editor@bshaanews.co.uk For BSHAA matters, contact the Secretary: 01371 876623 BSHAA, 9 Lukins Drive, Great Dunmow, Essex, CM6 1XQ www.bshaa.com

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From the Editor

4

News

5

From the President’s Desk

7

From the CEO

8

Product & Company News

12

Business Matters

14

Back to Basics: Otoscopy

17

AGM Report

19

Audiologist of the Year

23

How do we Modernise Attitudes to Hearing Care?

24

Code of Practice

28

An Open Letter to the Editor of Which? magazine and the RNID

31

Marketing Matters

34

Recruitment & Classified Advertising

36

BSHAA NEWS | WINTER 2010 3

from the editor

from the Editor

Can it really be nearly Christmas already? What’s happened to “TwentyTenty”? Has Roger’s Presidency really been and gone? But even more importantly, have we seen the end of the recession with more people now buying hearing aids again? Perhaps if we all adapt and adopt from Curtis Allcock’s stimulating article on page [?] we can help get the tills ringing to join in with the sleigh bells.

It is also appropriate here to thank Roger Lewin for all of his hard work and effort [not to mention long hours spent] as your President for the past two years. There has been a lot of change during that time, which I’m sure incoming President Peter Ince will be keen to progress. I’m sure you’d join me in wishing them both well and continued success.

On the topic of “wishing well” I feel that some people may have thought that leaving the HAC for HPC was getting their ultimate “wish”. Barry Downes’ excellent address, at our recently well attended AGM in the Mary Hare facilities near Newbury, reminded us of our responsibilities for CPD and the importance of being professional. Similarly, Robert Rendell suggested just a short time ago that whilst the HPC might be “a light touch” they certainly were not going to be “a soft touch”. This is shown quite starkly if you visit their pages for our profession upon which are their judgments; this season apparently will not be a “Joyeux Noel” for some.

However, if you enjoy a little bit of “look & learn”, then our next edition of the “Cut Out & Keep” series is available this time on Otoscopy for which we are grateful once again to Michael Michelson, an unsung warrior of many an Education Day. Elsewhere we have some more insight into an article published recently about a very small sample of mystery shopping in our profession, not sure of its name but you probably know which one. Contributors to this avenue of interest include Hugh Crawford [page ?] and David Mould [page ?] and we applaud this desire to become involved. We are also pleased to publish a heart-warming update on Gordon Gipson and his “PICU THE PENGUIN FUND”.

Don’t forget to ask Santa to bring you some tickets for Congress 2011 and if you don’t believe in the man with the white beard and funny accent [no, not Alan Torbet], you’d better send your requests to Jill. Though if you don’t make a wish… I’m still hoping for mine to come true! Enjoy the Festive Season and may the only thing to be bursting come January is your appointments diary! Merry Xmas all!

Ian Croft | Editor editor@bshaanews.co.uk

BSHAA News and the BSHAA Secretariat wishes all members a happy festive holiday and peaceful and prosperous new year.

4 BSHAA NEWS | WINTER 2010

have you heard?

Top Congress speakers the highlight of a packed year of study in 2011 nother line up of top speakers is planned for the 2011 BSHAA Annual Congress which is expected to be the highlight of a full study programme for members over the next 12 months.

As well as Congress there’ll be three study days and five of the half day workshops which were trialled during 2010.

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This year Congress moves to the East Midlands where the venue on May 13th and 14 will be the Conference Centre in the beautiful grounds of Nottingham University. As well as a packed education programme including one of Britain’s top customer care experts, there’ll be a Congress Party with a star cabaret and dancing to a top band.

Conference headquarters will be the Crowne Plaza Hotel in the centre of Nottingham and there are other hotels of varying price in the streets around. Coaches will ferry delegates back and forth which means there’ll be no parking charges to pay either.

More details of the programme will be revealed when the booking forms are

sent out in January but one speaker already signed up is Ted Johns, writer of several books on Customer Care and founder of the Institute of Customer Service. He now runs his own consultancy and coaching business, The PROSPER Consortium, and is a Chief Examiner for both the Chartered Institute of Personnel & Development and the Association of Business Executives.

It is hoped the event will also see the launch of a new BSHAA website which, for the first time, is likely to include the facility to record CPD activity online as well as prepare CPD submissions to the Health Professions Council.

The Education Committee has done its best to plan events for the year at locations and times that enable as many people to attend as easily as possible. The Study Day year kicks off on March 12th when the location is Stansted, an ever popular venue which attracts good audiences from the North and South. Congress is in

May in the East Midlands while on September 10th, the Arlington Arts Centre at Mary Hare School in Berkshire, will be the venue. Again this venue is always well supported.

The annual meeting and Study Day will be on November 12th in Manchester.

Interspersed will be five half day events at venues and on dates to be announced in January. However they are likely to be in Burton-on-Trent and on the South Coast in April, Yorkshire, in July, Scotland in September and Bristol in October.

As ever the Education Committee is always keen to hear from members who have ideas for subjects they would like to see covered and indeed for speakers they have heard elsewhere and believe would be appreciated by the membership in general. They are also always keen to talk to people who might want to help with event organisation. Drop the registrar an email: michael.nolan@ascentinvestments.co.uk

Gordon buys equipment for hospital that saved his Granddaughter Readers of the summer edition of BSHAA News will remember the story about Tyneside member Gordon Gipson who set up a money raising charity the PICU THE PENGUIN FUND to help provide vital new equipment for a hospital where his Granddaughter underwent a successful heart transplant operation.

Four-year-old Martha Andersen was just 15 months old in January 2007 when she was rushed to the Paediatric Intensive Care Unit of the Freeman Hospital, in Newcastle, with second stage heart failure.

Gordon and his wife Alex were so grateful to the hospital for saving their granddaughter they pledged to raise £50,000 to support a two bed expansion of the unit, which services families from all over the North-east.

Gordon tells us that having reached £47,000 they went ahead and ordered the equipment, which includes a dialysis machine and a gas machine. It has now been delivered and installed.

In a note of thanks the lead sister in the unit explains how the new kit has made it easier for the nursing staff to concentrate their care on each patient and eased pressure on the dialysis equipment. “I cannot thank you and your supporters enough for your generosity,” she says.

Meanwhile Gordon has asked BSHAA News to say a huge thank you to everyone for their support. “As I have said on a number of occasions, YOU have made all this possible, and for that we are eternally grateful. I recently paid a visit to the unit and to be honest their gratitude is extremely humbling.”

BSHAA NEWS | WINTER 2010 5

from the president’s desk

from the

President’s Desk ur services have recently received the attention of Which? magazine and it is important to relay how BSHAA has responded to the issues that it raises.

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Having read the article you will, I am sure, be disappointed with its content.

Despite that disappointment I believe it is important to accept the findings and consider their impact on our services and think about what we might be able to do to improve the experience of our customers.

In accepting the findings we must not be dismissive of the message it contains.

The article mentioned specific companies and some more negatively than others but even if it escaped your attention I am afraid there is no room for complacency. The article did not paint a positive picture of private hearing care and will not help consumer confidence in what we do.

It is always possible that such articles could find wider coverage in the media and I would like to reassure members that even thought we were not called upon to respond to the issues in the article, BSHAA was briefed and ready to participate in any discussion on any platform. David Peel and Alan Torbet prepared statements and key council members were briefed and ready to appear for interview as and when required.

I should acknowledge that some members expressed the view that BSHAA should take the offensive and respond aggressively to the content some even comparing private services to public service. I believe that this was not considered the right approach.

This is not about comparing services, the correct response is to examine to our own standards and ensure we do everything possible to understand how we can avoid future disappointments.

Having accepted the criticism of the Which? investigaton, the constructive approach is to try to do something to overcome the negative findings. Part of BSHAAs response was naturally to approach Which? and the RNID (who performed the assessment of the mystery shopping exercise) to ask them for a detailed report on the findings.

Regrettably neither organisation has provided further information.

This lack of co-operation is frustrating.

BSHAA also spoke to the companies named in the article asking for more detail, only to find that the they had also received limited information and were genuinely unable to trace when and where the mystery shopping had taken place. With a lack of detail BSHAA can only take the generalisations at face value and it might be valid to say what can be asserted without evidence can be dismissed without evidence.

BSHAA also had cause to communicate with the RNID about the possible inclusion of hearing aid services into a BBC3 program called Rip off Britain.

BSHAA learnt about the program having spotted an RNID communication to its members under the heading “Help us expose the hearing aid rip-off ” which requested members “willing to go on TV to tell their story” to contact them if they had bought a hearing aid privately which was already available on the NHS. An even more pointed appeal appeared on Twitter inviting people who thought they had been “mis-sold” a private hearing aid to get in touch. This is a very different situation to the Which? report since there is little to be constructive about.

The RNID communication was unbalanced and did not attempt to collect anything other than bad news stories.

This is deeply inappropriate and

BSHAA communicated with the RNID and the BBC on that basis. Pleasingly we established that the BBC had not received significant complaints against the private sector and inclusion into the program was not merited.

It may sound very odd because it is by no means pleasant to see critical comment on the services we offer, but it is actually OK for us to be engaging in constructive discussions about the standard of service that we offer our customers. If we can have meaningful and relevant discussions about how to improve our customers’ experience we should be pleased, this is a step up from the recent past. We will always have to prove ourselves and demonstrate that we provide a service that is fit for purpose and we should not be shy of any opportunity.

I would like to give my grateful thanks for the opportunity of being President.

There was not a moment when I was not proud to represent the Society’s Members who are a sincere group of professionals dedicated to providing satisfaction to their clients.

Roger Lewin

Roger Lewin, BSHAA President

BSHAA NEWS | WINTER 2010 7

from the ceo

welcome to the

mainstream

by Alan Torbet t took nearly 5 years, but our regulation has now been modernised. In 2010 we are now in the mainstream of statutory professional self-regulation; on a register of 200,000 plus health professionals, from 15 different professional groups.

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BSHAA is the professional body for hearing aid experts – the 1536 Hearing Aid Dispensers registered with the Health Professions Council.

In 2010 we have issued guidance to support dispensers meeting the general standards required by the HPC. Our Foundation Degree is fully established as the minimum entry qualification to the profession. Its “earn as you learn” structure is exactly what our businesses want.

We provide CPD – this year we have trialled short sharp mid-week half day sessions – and next year we will be providing on-line software to help members maintain the personal CPD portfolio which the HPC requires.

Within the last few weeks our first BSHAA-approved Clinical Ear Care Practitioners have completed their training and are now providing a new wax management service to their clients.

As this is the first extension of the Hearing Aid Dispenser scope of practice, we have to ensure that standards are high, that safety is paramount and that competence has been externally assessed. We know that we cannot afford any mistakes – ENTs and nurses will be watching!

8 BSHAA NEWS | WINTER 2010

We have also defined a new supporting role for Hearing Care Assistants, with nearly 60 of them on the first 2 courses being provided by Anglia Ruskin University. Approved HCAs will be the standard in the industry and will be on a BSHAAmaintained register. Clients will benefit with more time and support. Dispensers can be assured that they can safely delegate to assistants who are fully trained and competent.

And companies get a more flexible workforce, with HCA as an accredited stepping stone to Foundation degree and full professional qualification.

Our business regulation has also joined the mainstream.

Dispensing businesses, big and small, must comply with the same Consumer Protection Regulations as any other type of customer-facing business. Traders must not mislead consumers or unfairly pressurise them into making wrong choices; consumers should not be given less than they paid for; products should be safe and do what they are supposed to do; contracts need to be clear, and not unduly weighted in favour of the business.

But we in the private hearing care sector have gone further to show that we are capable of self-regulation in our business practices, as well as in the professional. The vast majority of companies and independents have signed up to participate and some are now taking the next step and adopting the good customer care practices required by the Consumer Code approved by the Office of Fair Trading. BSHAA is now

from the ceo

providing the independent customer complaints resolution service through our Customer Care Scheme.

Showing that we are serious about consumer protection; showing that we are capable of self-regulation is vital to our future. If we cannot assure the public and our clients that their care, and their money, is safe in our hands, it will only be a matter of time before the state intervenes and heavy regulation is imposed again.

But, although most companies participate in the BSHAA customer care scheme, adoption of the OFT Consumer Code has been slow. I do not really understand the reluctance.

Being part of it says that you are serious about self-regulation. Going beyond it means that you really do welcome consumer feedback as a useful tool for improving your business. Look at the way one high street bank is promoting the quality of its service to customers through its Customer Charter, and a new-found willingness to listening to what they actually want.

Better late than never! Who would have thought that customers want their banks to be open at more convenient times, and staffed so that you don’t have to wait in a long queue?

We in hearing care now need to give serious consideration to developing a Customer Charter, with transparent service standards and a transparent pricing structure. Customers need to know what they are getting for their money, and what the price will be before they commit. Do we need to go this far? Yes we do.

In the last few months we have had a challenging report from Which? magazine about the quality of hearing aid assessment and testing, and a threatened programme on hearing aids in the Rip-off Britain BBC TV programme series. Negative public perceptions about poor practice in our sector will not be easily corrected.

All well and good, but how does all this play out in a market place dominated by free NHS provision? Over 1.1m hearing aids were supplied in the UK last year; an increase of 30% since 2003. Now, as then, over 80% are provided free through the NHS compared with less than 20% purchased from private Hearing Aid Dispensers.

Driven initially by the NHS introduction of digital technology, and then by government-imposed treatment targets, the provision of free NHS aids peaked at little short of 1m in 2008. The provision of free NHS hearing aids, with on-going maintenance and free batteries for all, is estimated to have cost £1.1bn over the last 5 years.

Self-funding of hearing aids probably accounts for another £1bn.

Showing that we are serious about consumer protection; showing that we are capable of self-regulation is vital to our future. If we cannot assure the public and our clients that their care, and their money, is safe in our hands, it will only be a matter of time before the state intervenes and heavy regulation is imposed again.

This huge public and private investment gives us uptake levels which are amongst the best in the world.

Despite this there are still around 4 million people in the UK who are currently not taking any action to address their hearing loss, and this number is projected to increase with the prevalence of social noise damage and an increasingly older population.

Fitness for economic activity will be even more important as state pension age extends.

So definitely an expanding market!

But then, along come the bankers, economic meltdown and, as the Governor of the Bank of England says, “10 years of austerity”! And a UK government determined to recover

the deficit in 4 years; radically reduce state spending; and reform the NHS. So generally people will have less money, some will have no job, or a lower-paying one. People who are able to be in the market for private hearing care will want to pay less, and get better value.

“How’s business?” I asked a dentist friend of mine recently. “Well” he said “people have still got money. I just hope they continue to spend it with me!”

So the government intends to liberate the NHS – in England at least – which will make it more efficient, while spending less – £20bn less next year apparently. Efficiency will be a real challenge. The NHS did not manage to improve efficiency at all over the last 15 years, and that in a period when spending went up by 30% in real terms.

It appears that the government will be looking to the private sector to take on work, but I am not at all sure that the terms will be attractive. I am not impressed with glib words from civil servants – suggesting that the private sector needs to “go out and show GPs how you can save them money and do a better job”. This shows a real lack of awareness of basic business economics!

Liberating the NHS starts with the usual platitudes about putting patients first, being more responsive and being free.

But it gains traction for me when it says that quality should be judged by outcomes, not by compliance with processes and systems.

The NHS may, very quickly, have put a lot of free hearing aids into patients’ ears over the last few years, but there is no evidence that this achieved the outcome of a general improvement in the hearing status of the population.

To benefit from a hearing aid you first have to wear it – but the NHS doesn’t ask about that when they look at the quality of patient experience. Many NHS hearing aids may end up in drawers soon after they have been fitted, and there is no effective follow-up.

This could be a huge waste of public money, and there is a risk that the whole experience of adult hearing care provided at NHS clinics and hospitals could be devalued. Whether a patient wears their hearing aid is a fundamental indicator of outcome benefit and it should be measured in future.

BSHAA NEWS | WINTER 2010 9

from the ceo

A US study of private hearing aid customers suggested that 12.4% of aids may be ITD (In The Drawer).

We in the UK industry cannot escape criticisms of ITD. Like the NHS, we do not measure rates either. We could lead the way – virtually all hearing aids automatically log usage; and I noticed that the Eartrak client survey questions are rightly biased to eliciting information about patient benefits from wearing the aid.

Liberating the NHS gives a commitment to greater choice for patients, from any willing provider. This is music to our ears. A clear end date of 2013/14 for making it a real choice from any provider – NHS or private – which complies with NHS quality standards and prices, is welcome. The government believes that the NHS will be run better by clinicians, not managers, and intends to give GPs control of £80bn, the vast majority of the commissioning budgets for NHS services. GP consortia are, it is said, best placed to understand local needs, and to commission the best care from NHS Hospital Trusts and other willing providers.

Conveniently this allows the government to abolish whole swathes of NHS organisations, quangos and managers – which will instantly reduce bureaucracy and improve efficiency (they say).

In BSHAA’s response to the government’s consultation on Liberating the NHS, we ask ourselves whether the needs of people with routine hearing concerns best served in the NHS. We do not think so. Most hearing loss is not a disease which needs to be diagnosed by a GP and treated in a hospital clinic. We believe that people should have genuine choice of their

hearing care provider and that means that they should be able to go direct, not have to wait to be seen and referred by their GP. Giving people the choice to go when they want and where they want will give them more control. As a result, they will take more responsibility for their hearing, take more interest in the hearing assistance they need; and be more likely to use the hearing aid fitted.

A choice of personalised hearing care on the high street, when you want it, is much more attractive and effective for people with hearing concerns – and will be valued more than an equivalent service through a hospital.

We are concerned that hearing aid provision will not be a priority for GP commissioning and we do not think that it is fair to patients to return to the bad old days of post-code lottery, when the NHS service you got, and how long you had to wait for it varied from place to place, and from one side of a street to the other.

So we think that hearing aid provision should be commissioned nationally, with national standards for access, quality and prices. National standards would also be fair and more efficient for providers. It would allow the market to respond effectively and compete on quality rather than face a “race to the bottom” on price – which we do not believe is in anyone’s interest.

Finally, we want every dispensing business which wants to – large, medium, small and sole traders – to be able to become approved providers for NHS hearing care. Clear, simple,

national criteria for quality and approval will help; costs of compliance should be reasonable, and proportionate to the size of business involved.

Diversity of provision should be encouraged in NHS hearing aid provision. It works for patients of other primary services such as pharmacy and optometry. But one thing we do not comment on is whether patients should have the ultimate control and choice.

Should they be able to use their NHS service entitlement as cash and be able to top it up with their own money for a better level of care? The voucher word is still unspoken in the NHS, but government cannot be far away from using it. I see that it has now been used in Education.

The government has to reduce spend, which is challenging while demand continues to rise. Offering a voucher which guarantees a basic level of free service and the choice of topping up for something better does not breach the principle of a free NHS. There must be an economist working away now, trying to asses the lowest voucher value which will stimulate the market for providers; and act as an incentive for personal top up; but save the government money now and into the future; and cap the financial risks of a massive uptake of rising demand.

So, one prediction for the future – it will be a lot less than 5 years before radical change affects our sector again!

Alan Torbet chiefexecutive@bshaa.com

Giving people the choice to go when they want and where they want [for their hearing care provider] will give them more control.

As a result, they will take more responsibility for their hearing, take more interest in the hearing assistance they need; and be more likely to use the hearing aid fitted.

Alan Torbet Chief Executive BSHAA

BSHAA NEWS | WINTER 2010 11

product and company news

Product and Company News Phonak voted ‘Best Supplier’ or the second year running, Phonak have been awarded ‘Best Supplier’ at the Association of Independent Hearing Healthcare Professionals (AIHHP) awards 2010.

They were also credited twice in the product categories, with Certena Art once again being awarded ‘Best Entry Level Instrument’ and Naida as ‘Best Power Instrument’. Completing the collection of awards, the company scooped ‘Best Provider of Training’.

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Meanwhile Phonak has introduced what it calls the Spice Generation chipset. They say fast processing power, high capacity, large memory but small size are among its features.

The chipset also has stable wireless connections and a wide range of cable-free fitting choices to guarantee maximum performance and simple usability. The unique broadband, wireless real-audio exchange enables

features to make hearing possible in situations where it was impossible to hear in the past. There’s a new design approach – ContourDesign – for

smaller housings shaped to follow the contours of the ear. The company has also introduced new fitting software Target FM.

Medicinal olive oil, the panacea for ear wax? n old product in new packaging to help people who have problems with ear wax has been launched by the Huddersfield based healthcare products firm Thornton and Ross.

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Cerumol Olive Oil Drops takes on Earol (an olive oil spray) which has been on the market for some time now. The company marked their launch with a new report which reveals that 84 per cent of British doctors believe ear syringing can be a risky procedure, with an additional 76 per cent who believe that a large proportion of the £23million spent on ear syringing could be avoided if people took better and regular care of their ear health. Two hundred GPs took part in the Cerumol survey which found that 70 per cent of GPs believe regular use of an over-the-counter

12 BSHAA NEWS | WINTER 2010

treatment to prevent the build up of excessive ear wax could help reduce the need for ear syringing. Almost two thirds (57 per cent) of GPs said that a medicinal grade olive oil could offer an effective solution when used regularly. Half of the GPs surveyed (53 per cent) had treated people who had suffered damage to their ear drum due to being too vigorous with a cotton bud.

Despite this, a further poll of 4,000 UK adults (One Poll survey – August 2010) uncovered all kinds of ill-advised techniques employed to remove ear wax including chewing gum (seven per cent); pens (six per cent); and fingers (20 per cent). One in five (21 per cent) of the people surveyed said they regularly complained of muffled sound because of blocked

ears and experience frequent disruption to daily life as a result.

65 per cent of people have noticed an improvement in their hearing after earwax has been removed.

product and company news

Thompson and Young join Phonak Aaron Thompson and Chris Young have joined Phonak as Regional Sales Managers for the North of the Country and Scotland/Ireland divisions respectively. Aaron will begin to manage accounts in the North from November and brings with him over 10 years of sales experience including pharmaceutical healthcare for both the private market and the NHS. Chris Young has taken over over the Scotland and Ireland division from Craig Purdie who has a new role within the Sonova Group. Chris’s previous jobs included a successful career with SEIKO UK, developing Key Accounts within a National and Independent market.

Ran Meyrav

Ran to expand Amplicom’s UK business Aaron Thompson

Chris Young

Metzdorff moves to Switzerland

Jan Metzdorff

Phonak UK Managing Director, Jan Metzdorff has moved to lead a new International Sales organisation set up by Unitron in Switzerland.

He’s to be Vice-President, International Sales and will provide sales, marketing and training resource support to customers. Mr Metzdorff has had senior roles in the hearing industry for many years and is a longstanding member of the Sonova Group (which owns both Phonak and Unitron). In his previous role, he was instrumental in strengthening and managing both the Unitron and Phonak brands in the UK.

Ran Meyrav has joined Amplicon as European Sales Manger.

The firm says Ran comes to the UK with a great deal of experience in the marketing of assistive listening devices in various sectors and he is excited by the challenge ahead of him.

PC Werth completes management line up PC Werth has appointed Stewart Howell, as Director, Hearing (responsible for all audiology and personal hearing healthcare markets). He joins Irene Rutherford (Director, Listening – responsible for education and group communication markets) at the sharp end of the revitalised PC Werth sales organisation.

Stewart Howell

Irene Rutherford

Widex continues to take control As Widex continues to take control of its own destiny it has bought out the company that distributes its products in the United States. Widex USA was set up nearly 55 years ago and by Danes Harold Spar and Henry Meltsner but in an open letter their sons Eric Spar and Ron Meltsner have announced they have sold their company to Widex A/S in Denmark.

The pair blamed eroding margins and the need for significant investments to expand Widex’s position in the market, and ensure superior service to US hearing professionals.

BSHAA NEWS | WINTER 2010 13

Businiess Matters

Looking after your

records

by Jill Humphreys

ispensers often ask the Secretariat if there are any rules about how long they should hang on to a patient’s records. Unfortunately there is no easy answer and certainly there is no statutory period laid down. In the BSHAA Guidance on Professional Practice the recommendation is seven years. This recommendation was made after the Society consulted with other HPC professions to find out about their practices. Their records and those of HADs are classed as health records held outside of the NHS. The British Medical Association guidelines recommend 10 years for Medical Records. The final decision then is really down to the individual or company and may even depend on how much storage space is available.

The Society would not however, recommend that you destroy records for at least seven years.

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It is worth bearing in mind that under the Data Protection Act of 1998 a patient has the right to ask to inspect any records you keep which relate to them. According to the Act a record is any information relating to the physical or mental health, or condition of any individual which has been recorded by or on behalf of a health professional in connection with their care.

Businesses should have a procedure for recognising any requests for access to a patient’s records and a process for dealing with them. It is good practice to make a log to track these requests

14 BSHAA NEWS | WINTER 2010

through to completion. They should be acknowledged and the individual should be given an indication of when they can expect a response. A response must be dealt with within 40 days.

Section 7 of the Act gives an individual the statutory right to see information held about them. The request must be made in writing and should include full name and address of the person seeking access to their health record.

The identity of the person who made the application should be verified. If the client is a current client you or your colleagues may be able to vouch for the individual - otherwise you should ask for documentary identification.

If the request is received from a third party you must be very careful to satisfy yourself that they have the authority to make this request on behalf of your client. The Society would recommend written authority signed by the client.

(On a practical point, it might be beneficial for the individual to be advised that if they want a copy of the audiogram another dispenser would probably want to re-test anyway. The public that have contacted BSHAA on this issue thought that an audiogram works the same way as an optical prescription.

When advised of the situation they have reconsidered their request) Young people over 12 years must make their own request and would

have to agree to such a request being made by their parent or guardian or any other third party, unless you judge that the young person is not mature enough to make their own decisions.

Finally you would need to satisfy yourself that the person making the request is allowed to act on their behalf and is acting in their best interests. We recommend that you exercise caution and refer, if necessary to a GP. It is up to you if you wish to make a charge for providing copies of personal records. If you do decide to charge, the fee should cover the cost of copying and posting the records and should be proportionate to the number of records involved. The charges must not exceed the following: • Information held on a computer system only – £10 • Information held in a manual filing system or a combination of electronic and manual filing – £50 These charges are VAT free. Instead of providing copies you can offer the applicant the opportunity to inspect the records in person if the records are held manually and have been added to in the previous 40 days; you cannot charge for this.

You can ask the patient or their representative, (as this might help you decide if the representative is acting in the client’s best interests) the purpose of their request but they are not obliged to provide this information.

business matters

However you are obliged to provide the information requested together with: • A description of the information • An explanation of why you keep the information and • A list of people to whom you may disclose the information and an explanation of why you may do so.

If there is information in a patient’s records about a third party you must be very careful about disclosure of this information. On reaching your decision you should consider the interests of all the parties before deciding whether or not to disclose this or withhold parts of an individual’s record relating to that third party.

Jill Humphreys, BSHAA Secretary

BSHAA News Reader Competiton

Win one of the loudest alarm clocks in the world!

The Amplicom TCL 200 is being billed as “The Alarm Clock You’ll Never Sleep Through” and you can win one in this BSHAA News Reader Competition.

At 90 decibels it is one of the loudest production alarm clocks on the planet. Ideal for people with hearing impairments – flashing LED lights and a cordless vibrating pillow pad ensure that anyone will wake up to the TCL 200.

And on top of the ear-splitting wake-up call, the Amplicom TCL 200 is packed with the latest technology to help wake people who are deaf or hard of hearing: bright LED lights on the top flash when the alarm goes off and a cordless vibrating pad can be tucked under the user’s pillow to ensure there’s no chance of snoozing through the alarm.

All of the Amplicom TCL 200’s features are programmable.

The dual alarms can be configured with a choice of melodies, and the sound, light and vibration can be turned on or off to suit individual needs. Alarms can be set to go off daily, weekdays only or weekends only. You can even press the snooze button in the night to both see and hear what the time is.

For the hard of hearing, the Amplicom TCL 200 acts as more than just an alarm clock. You can also hook it up to a telephone to amplify the ring sound. Simple push buttons on the front and oversized knobs on the back make it very easy to use. The dimmable display boasts large (3cm high) numbers too. Easy to configure, incredibly loud and impossible to ignore, the Amplicom TCL 200 is the ultimate in wakey-wakey technology.

Costs £54.99 and is available from Hearing Product specialists.

Win To win a TCL 200 all you have to do is answer the question: The TCL 200 is one of the loudest alarm clocks but what is the quietest clock that exists?

To enter, write your answer, name, address, telephone number and email address on the back of a postcard or sealed down envelope and post it to Marketing, BSHAA News, 7 Kings Avenue, Stone, Staffordshire, ST15 8HD, to arrive no later than January 31st. You can also email marketing@bshaa.com. Results will be published on the BSHAA Website and in the Spring Edition of BSHAA News.

The Editors decision is final.

BSHAA NEWS | WINTER 2010 15

back to basics

Despite all our best efforts, knowledge gained is often knowledge forgotten as in our day to day practice we introduce short cuts we have learnt. Best practice can mutate into a mixture of what should be performed and what is quickest and easiest.

These refresher articles will give you a chance to think of what should be done and compare it with what you actually do in your consulting room.

What’s that I see in there?

by Michael Michelsen Welcome to the second in the series of Back to Basics. This time we will be looking at the skill of Otoscopy. This is an everyday task we perform without perhaps thorough thought or any self-questioning about why and how this is performed, let alone the outcomes from this mundane task.

This article’s scope will be the entire process. The BSA document – Recommended Procedure Ear Examination published earlier this year – is the core document linked to the BSHAA practice guidance and the HPC standards. The other relevant BSA document – Recommended Minimum Procedure for the Cleaning of Specula etc and Associated Infection Control – has now been withdrawn pending a major review and update. I will not be attempting to look at these procedures or to rewrite them but hopefully everything will fit around these existing documents.

Equipment Obviously an otoscope – but which one? Is a basic model appropriate or do you want a tool that you are really happy with? For me it is like using a nice high quality pen rather than a cheap ball point pen which you can get for 10 pence each. I use an otoscope with a much wider angle of view and an adjustable dioptre eyepiece. Next time you attend the Congress (East Midlands Conference Centre, May 13th and 14th 2011) have a good look at the kit that is available and see which you feel is best for you.

I would suggest that the sales people from equipment suppliers are worth chatting to.

A good supply of clean or disposable appropriate otoscope specula or tips is required. The use of single use, disposable tips is to be commended.

Make sure that the otoscope actually works and that the light is not dim.

Whenever I change the batteries in my otoscope, it never ceases to amaze me just as to the degree of difference in brightness that I am able to perceive.

Work space and preparation Your workspace needs to be organised and prepared prior to any examination being conducted. For those who work in a branch thought should be given as to the layout of the office space. All equipment should be within easy reach, and the positioning of the client’s chair should allow comfortable easy access to both ears.

Also available are video otoscopes. I have used these many times but I have not yet found them to be as comfortable to hold as a normal one. This perhaps is more to do with unfamiliarity.

However with the advent of the medico-legal society we as a profession face, as well as the increase in telemedicine, there will be a rise in the demand for captured images to be stored in the patient’s file in whatever PMS that is used.

BSHAA NEWS | WINTER 2010 17

back to basics

Holding an Otoscope The BSA procedure will determine this in a more detailed manner, however the otoscope should always be held horizontally with the back of the examiner’s fingers touching the client’s cheek. This will ensure that any movement made by the client will be shadowed by the otoscope thus preventing any damage to the ear.

The desk area should remain uncluttered to allow regular cleaning of the desk area between each client.

If you are working in the home environment your domiciliary case should be clean and organised. When you arrive in your client’s home you will need to take charge and find the most appropriate room in which you will want to work in and then ensure the layout of the seating will permit you appropriate access to your client’s ears.

Your hands need to be washed before any approach to the patient is made.

Contact with patient The patient needs to be sitting on a secure seat in a space that allows you to work around the them safely without being crowded out by other pieces of furniture, the shape of the room or ‘significant others’. You need to be able to position yourself securely either braced in a kneeling position or preferably seated.

The patient needs to be briefed on what you are about to do, why this is about to happen and what is expected of them. It is vital they are instructed to sit still. This conversation needs to happen in a face-to-face manner so that the patient is able to lip read if this is required. Prior to beginning the examination you should explain that if they feel any discomfort then they should raise their hand to allow you to stop before any conversation takes place.

Ensure that the patient has heard everything and that they have understood all that has been said.

Ask your client about any past ear-related medical history especially perforations, earache, discharge, or previous operations. I have always found it worth stressing the phrase ‘at any point during your life’ when asking about the operations.

18 BSHAA NEWS | WINTER 2010

Outcomes OK, so far so good, but what exactly should you be looking at?

Before you even pick up the otoscope, look at the patient and their head to ensure that there are no obvious issues or concerns.

Next, use the otoscope without the speculum to examine the skull around the pinna noting any abnormalities or operation scars.

Look at the pinna for scars, at the crest of the pinna/helix for abnormal skin. As Hearing Aid Audiologists, none of us are dermatologists therefore any abnormal skin should be referred to the GP. Obviously the major area of concern is skin cancer but all abnormal skin needs to be seen and assessed. Still using the otoscope without the speculum look into the ear canal to judge what size speculum should be used.

With this knowledge, affix the correct size tip which has been wiped with a disinfectant swab. Touching it as little as possible, check that it is fitted properly, and then look into the entrance of the ear canal.

Look carefully at the skin of the External Meatus going slowly deeper before eventually examining the ear drum.

All findings should be accurately recorded at the time. When I used a paper based system I always had an image of each eardrum on the report card which I would then mark as appropriate.

Please always get used to thinking of the ear for the purposes of otoscopy in terms of three sections, pinna, ear canal and ear drum. It is too easy to fall into the trap of just looking at the ear drum and nothing else. Do however carefully consider and document all three sections.

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Momentous year reviewed at

Society AGM he end of a “momentous” year which has seen the hearing care sector move from regulation by a code of trade practice to registration as health professionals was marked at the Society’s annual general meeting in Berkshire last month.

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Almost 150 members attended the event at the Arlington Arts Centre, near Newbury, which was followed by a full study day.

It also marked the end of two years of office for President Roger Lewin who formally handed over the chain of office to the current Vice-President, Peter Ince.

Roger thanked the audience for giving him the opportunity to be President.

“A number of people have graciously mentioned that it must have been hard work, but actually it was never a chore and the integrity of the members gave the office its authority,” he said.

Introducing the new Present he said Peter Ince had been an HAD since 1984. He had retired from dispensing 3 weeks ago which benefited BSHAA strongly because he would be both dedicated and independent.

Peter had been at the centre of the key work streams important for the future including Customer Care and Standards and was informed and knowledgeable on all of the issues. He was confident he would exercise good judgment and would be representative of all members from all sectors.

In a question and answer session while votes were counted for the elections to the Council, Roger Lewin described the processes that had been gone through in the weeks in advance of and after the publication of the Which? magazine report.

He described the Society’s response as proportionate: no-one had been pleased to see what had been written in the magazine nor would they want

to defend the findings. However the matter hadn’t been picked up by the media and it was right that BSHAA was restrained in its responses.

However, he said, that didn’t mean that much was going on behind the scenes.

Both the RNID and the magazine had been asked to hand over their findings so that the Society could itself investigate and, if necessary, take action. This request had so far been ignored.

He also explained how the Society had robustly criticised the RNID decision to embark on what he called a “fishing expedition” to try and find complainants for the BBC Rip of Britain series. The Society had also approached the BBC. As it turned out, he concluded, this programme never got off the starting blocks because only two complaints had been forthcoming.

independent and retail dispensing continues to be vibrant in the UK by helping align standards and practice delivery. Trevor is 47 years-old, married, and lives in Sussex. Outside of work – aside from enjoying spending time with family and friends – he plays hockey in one of the veteran sides of a local club – “more fun than fast paced,” he says. In addition, he sits on the committee to ensure it provides the right facilities for the players and coaches for today and into the future.

Colin Campbell has been a RHAD for 14 years and joined BSHAA in 1997. He was already a member of the Society’s Education Committee and the group responsible for the introduction of the hearing care assistant role. He is Director of Professional Services for Specsavers having previously worked at Scrivens and Hidden Hearing.

New faces on the Council Two new faces will sit on the BSHAA Council when it meets for the first time in 2011. Trevor Andrews and Colin Campbell were successful in the vote at the AGM. Retiring members Karen Finch and Roger Lewin were re-elected but another retiring member Michael Michelsen did not get sufficient votes to retain his place. Afterwards he said he was disappointed but slightly relieved, and would continue to work for the Society in any way he could. The president thanked Michael for his contributions in the past and paid tribute to Jo Farquhar and Steve Orchard, both of whom stood for office but were not successful.

Trevor Andrews is an Associate Member of the Society and is Managing Director of Siemens Hearing Instruments UK. He joined the company after 25 years in the healthcare industry. Over the last three years he has been involved in many lobbying areas to help support the hearing care sector. He is fully committed to ensuring that

Trevor Andrews

Colin Campbell

BSHAA NEWS | WINTER 2010 19

agm

He says he’s passionate about improving standards of clinical and commercial service and that it is in training and education that BSHAA has a crucial role to play. Colin’s wife Julia is an Optometrist and they have an optical practice in St Andrews, Fife – the home of Golf (although he says he is the only man in the town who does not play). In fact his hobbies are following Aston Villa Football Club, which he has done since he was a boy, though he now faces a 700 mile round trip for home games, and walking in the Lake District.

Education Day Failure to meet CPD requirements could cost you your job A packed education programme which followed the AGM included a detailed explanation of how members can build their CPD portfolio. Barry Downes has produced a range of templates which members will find useful in recording their CPD including ones for case studies and reflective journals.

(Details of all these can found in the members section of http://www.bshaa.com/members/latestnews.aspx).

Paul Lamb, Starkey

Barry’s talk stressed that CPD was no longer a case of attending a set number of study days and ticking the points box. It was now a serious business that needed planning and administration.

It was vital to be recording CPD on a continuous basis: in 2012 the HPC would select at random a percentage of registrants and ask them to provide evidence of their CPD activity. Although some time was allowed for the submission, if the relevant documents weren’t received by the HPC in time or if they failed to adequately demonstrate compliance, a registrant would not be able to renew registration and in effect be unable to practice.

Michael Nolan, Roger Lewin, Jill Humphreys and David Foley

Not all leaders are born: some are made A common myth that leaders are born, not made, was exploded at the conference by Dr Stephen Brookes, Senior Fellow in Public Policy and Management at Manchester University Business School. Dr Brookes (above) first explained that every business – small or large – needed leadership and then traced leadership thinking over the centuries. He said good leaders were team players who asked the right questions but then allowed their team to come up with the answers… and he stressed that leadership could be developed with experience and training.

He went on to say that one common attribute was vision: leaders needed a clear vision and ability to inspire their teams however Dr Brookes stressed the need to be aware of the past while remaining willing to be innovative in the future; to experiment, reflect, and be willing to change the business and the people.

Devah Jackson, Resound UK 20 BSHAA NEWS | WINTER 2010

agm

Wendy Davies, Siemens

Chris Cartwright

Alison Stne, Oticon

Roger Lewin and Peter Ince

Victoria Dixon & Christine Flanigan

Paul Leeming, Widex BSHAA NEWS | WINTER 2010 21

audiologist of the year

Hearing Aid expert is

Pride of Scotland A BSHAA Fellow has won Britain’s top award for the profession and been named Audiologist of the Year avid Bryce, who was nominated for the prize by patients, runs the Scottish Hearing Services centre with his family from Aberdeen and is the first Scottish professional to win the Audiologist of the Year title.

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He is an experienced professional who has been caring for patients for over 20 years and was nominated for the award by regular visitor, Brian Johnston.

David said: “Brian is someone who’s been coming to my clinic for many years so I’m very touched that he went to the effort of voting for me.

I feel very proud to have won and happy that the service I provide is appreciated by patients like Brian.

CEO, Alan Torbet, Tom Davison, a consultant at the RVI Hospital in Newcastle and Gillian Lacey from Hearing Dogs for Deaf People.

The competition is run by hearing aid battery maker Rayovac and is now in its third year. Paula Brinson-Pyke of Rayovac says: “David demonstrates all the qualities of an outstanding hearing professional. He cares deeply for his patients, shows great sympathy and compassion and works incredibly hard to help them get them the right support they require.

Besides the winner, sixteen other hearing professionals were highly commended by the judges for their

work. They include Gareth Morris, Hearing Aid Solutions; Tony Vaughan, Hidden Hearing; Tara Tripp, Tara Tripp Hearing Care; Robert Beiny, The Hearing Healthcare Practice; Jenny Crenshaw, Hidden Hearing; John Lloyd, Crystal Hearing UK; Jo Farquhar, Taylors; Alistair Kinsey, The Hearing Company; Ivind Thoresen, Kingscross Hospital; Alan Walshaw, Keighley Health Centre; Jo Rae, The Hearing Healthcare Practice; Nick Chitty, Oxford Hearing Centre; Stephen Fairfield, House of Hearing; Sid Sidhu, Regional Hearing; Deepak Jagota, Oxford Road; Shona Jackson, House of Hearing.

“It’s very much a team effort as well, as I rely a great deal on my colleagues to provide on-going support and aftercare to patients.”

In his nomination, Brian praised the high quality of David’s care, highlighting his knowledge of hearing, his compassion and understanding of patients’ problems, particularly the time and care he takes to explain what he is doing and discuss any technical issues. He also highlighted David’s attention to care extended to driving more than 200 miles to visit him at home in Thurso and getting to know his family.

The award continues to attract a growing number of high quality entries year-on-year and was judged by an independent panel of industry experts including the Society’s own David Bryce (centre) with Rob Metcalf (left) and Colin Brinson-Pyke of Rayovac

22 BSHAA NEWS | WINTER 2010

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modernising attitudes

How Do We

Modernise Attitudes to

Hearing Care?

by Curtis Alcock e don’t have to be involved in hearing care for very long before we realise just how negative people’s attitudes are towards what we do. It’s as if we have to peel away the layers of resistance they bring with them into our consulting rooms before we even get the opportunity to work with them to improve their hearing.

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And those are just the people who have actually made it through our doors! According to the latest estimates, there are around 4 million people (and growing) in the UK who would benefit from wearing hearing aids but who have done nothing about it.

So why are we still failing to reach these people?

We often blame it on society’s negative attitudes, hoping that this will change “at some point in the future”. But people aren’t born to think this way; they learn these attitudes along the way – and the things that they see, hear and do all help to reinforce them. We also need to remember that Society does not change by itself; there are always instruments of change.

So if we want to see change, it’s up to you and me. But how?

• First, we need to understand where those attitudes have come from and why they persist.

• Next, we need to ask ourselves how we might personally, and as a profession, be reinforcing negative attitudes.

• Then we should consider what we should be doing or saying that would make it easier for attitudes to change.

24 BSHAA NEWS | WINTER 2010

modernising attitudes

In this article I want to introduce you to the five key drivers of attitudes to hearing care and show how we can use them to highlight some of the areas we need to be focusing on.

The five key drivers of attitudes to hearing care are: KNOWLEDGE

LANGUAGE

EFFECT

Our current knowledge about hearing.

This applies to what is known by science, what an individual’s knowledge about hearing (and their own), and what is considered “common knowledge”, e.g. “You should never stick anything in your ears smaller than your elbow”.

The language we use to describe matters relating to hearing. Language is very powerful; just one word can bring with it a flood of associations, memories, emotions and even belief systems. What sort of associations and emotions do our words create when we talk about hearing?

If we bring up negative associations, we have to work harder to overcome those barriers that we have inadvertently put up in someone’s mind.

The effect that a reduction in hearing has, not only on the individual with the reduction in hearing and their friends, family and colleagues, but also the impact on wider society’s perceptions, e.g. stereotypes.

Take for example, “If the sound is 85dB or more you should be protecting your hearing.”

Unfortunately 85dB doesn’t mean much to the person on the street, so they’re unlikely to recall it. It’s also not very easy to apply, unless we expect people carry a sound level meter with them! As a result, this message is unlikely to become common knowledge. So how should we change it?

As a profession we need to decide what are the universally important messages of hearing care, then find ways to present them to the public as “sticky messages”.

Language When you look at the language we use – hearing loss, hearing impairment, going deaf, ear mould (eugh!), etc. – it’s all very negative. Furthermore, it places the emphasis on the problem (which people want to avoid being associated with) rather than hearing, which is far more attractive. So are we shooting ourselves in the foot?

Think of how we describe someone as having a “hearing impairment”. English language dictates that the word “hearing” is being used here as an adjective to describe the type of impairment someone has. If I tell you you are impaired, how does it make you feel? Is it any wonder that people get defensive when they hear/read this?

ABILITY TO TREAT Our current ability to treat a reduction in hearing. Not only does this refer to the level of technology currently available and the associations that people attribute to it, but also the way we deliver hearing care. How acceptable is it? How relevant? How accessible?

RESPECT

How much respect we have for our sense of hearing. If people take their hearing for granted, then why would they be sad about the prospect of losing it? And if it's not important to them, why would they use your services?

These five drivers spell out the acronym K.L.E.A.R. – to help you remember. By understanding the drivers we can target them specifically and greatly accelerate the process of change.

Now let’s use these drivers to take a look at some of the areas we need to be focusing on.

Knowledge We all know that we should "brush our teeth twice a day to keep away the tooth decay"; it's common knowledge – the expert knowledge of dentists in a message that's simple, easy to remember and easy to apply, i.e. a "sticky message". Such common knowledge becomes the norm and the norm gets acted upon.

Very few of our “hearing care” messages have so far become knowledge, partly because we've never made those messages easy to remember and easy to apply.

BSHAA NEWS | WINTER 2010 25

modernising attitudes

How Do We Modernise Attitudes to Hearing Care? (continued) Or think how people use the word “Deaf ”. Not only does it sound like “death”, especially for someone who can’t hear the fricatives, but also reminds people of phrases like “deaf and dumb”. No wonder people who have been used to “normal hearing” all their lives want to avoid being labelled this way.

We need to take a leaf out of eye care.

If I wear glasses or contact lenses, I’m not blind! I’m “short-sighted” and “long-sighted”. In other words, I can see (sighted)! Not only does this fit in with my own self image, but it’s emphasising what I can see (e.g. “short” distances) rather than what I can’t. I don’t say I have a sight impairment or even sight loss. But here’s the interesting thing: even though it might emphasise what I can see, I still want to “fill in the gaps” for what I can’t. Why is that?

If we want to modernise attitudes to hearing care our language must be “fit for purpose”. Some words need redefining (should “deaf ” not be used the same way we use “blind” instead of being the general term it is currently?); some words will need to be replaced (e.g. earpiece instead of earmould?); some words will need to be invented (what's our positive equivalent of someone who is “long-sighted”?)

Effect Stereotypes about hearing have a nasty habit of becoming self-fulfilling prophecies. A person with an untreated reduction in hearing may wish to avoid being teased for “being deaf ” (see above) so avoid wearing a hearing aid which they think will label them with the stereotype. But by avoiding the treatment, their reduction in hearing is more noticeable and so confirms society’s stereotype, e.g. “deaf people are always getting words wrong”.

26 BSHAA NEWS | WINTER 2010

To break this vicious circle we need to define and manage the public’s perceptions, rather than allowing them to develop unchecked as they have done in the past.

To demonstrate how this can be achieved would require more space than this article would allow. In the meantime, consider how you think this could be achieved.

Ability to Treat Have you ever considered the steps a person must take in their heads before they walk into your consulting room?

First they need to think about their hearing and value it enough to want to get the best out of it.

Secondly, they need to believe they may have a problem.

Thirdly, they need to believe there is a solution and they’re happy to associate themselves with it.

Fourthly, they need to decide NHS or private (and perhaps see their GP). And finally, do they go to your practice or someone else’s?

That’s 5-6 steps. Each step that’s added into the mix increases delay, adds confusion (and time to be exposed to conflicting messages) and therefore indecision. And we wonder why people can take between seven and fourteen years to do something about their hearing!

When we carry out public awareness or write an advert, our readers will be at a stage in taking these mental steps. Also, our campaign may be the only information they get to take those steps, meaning that unless we expose them to the steps, they may not get all the way up the steps. But this

modernising attitudes

itself leads to a major problem: the more messages/steps we pack into our campaign, the more diluted our call to action.

Everyone involved in hearing care – Government, providers, manufacturers, professional bodies, charities – needs to take a holistic approach to these steps if we want attitudes to change.

For example, the Government need to promote routine hearing checks throughout life rather than “if you think you have a problem”. Manufacturers need to be advertising their technology to consumers instead of expecting hearing aid dispensers to do it for them. The NHS/Private dichotomy is outdated and needs to be brought into line with optics and dentistry.

Providers can then concentrate on differentiating themselves through quality of service and proposition, further improving standards of hearing care.

Such a holistic approach will have a huge impact on accelerating the modernisation of attitudes to hearing care – but it means all of us involved in hearing care in the UK working together to achieve it.

[This article is based on “Modernising Attitudes to Hearing Care – Part One” which can be downloaded from www.audira.org.uk.]

Curtis Alcock is a registered hearing aid dispenser with a practice in the south west of England. He will develop this theme in a lecture at BSHAA’s Congress in Nottingham in May 2011.

Curtis Alcock

BSHAA NEWS | WINTER 2010 27

code of practice

It’s been a momentous year for the profession and the approach of 2011, the demise of the HAC, and the Which? magazine report have stirred more than one member to write their thoughts about standards and practices in audiology. Here we publish two.

The HAC has gone but don’t consign its Code of Practice to the dustbin

by Hugh B Crawford s we head rapidly towards the end of 2010 it will not be long before we celebrate the first anniversary of the registration of Hearing Aid Dispensers with the Heath Professions Council and of course reflect on the first year since the demise of our old regulator, the Hearing Aid Council.

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We can consider the fact that the absence of a regulatory body and a Code of Practice with ‘legal’ standings may well free the dispensing world to make more informed, reasoned and autonomous decisions rather than simply doing things ‘by the book’.

However, the absence of ‘the book’, the Code of Practice, does not mean that its contents have immediately become old hat to be consigned to the dustbin. A ‘full and informed decision’ can still only be made by the dispenser (and the client) after a case history has been taken, otoscopy conducted, all followed by a full audiometric assessment.

Complete audiometry means testing all recommended frequencies by both air and bone conduction, applying masking rules where necessary with uncomfortable loudness levels tested as appropriate. All of these processes

28 BSHAA NEWS | WINTER 2010

need to be conducted according to the BSA Recommended Procedures with medical referral being made in line with the BSHAA Scope of Practice.

As I chat to others in the profession I am becoming increasingly concerned by those who choose to highlight the word ‘recommended’ in the BSA Recommended Procedures. It is almost as if they can now be considered as some kind of vague suggestion for audiometric testing, where we can accept those procedures we like, and ignore those we don’t.

The HPC Standards of Proficiency for Hearing Aid Dispensers requires us to “be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely and skilfully”.

It doesn’t actually mention the BSA. They also state that we should have the knowledge, understanding and skills “to select or modify approaches to meet the needs of an individual”.

Does this vary significantly from the HAC Code of Practice? I don’t believe so!

For example – a client has a bilateral hearing loss but with enough differences in the results to require bone conduction masking at all four

bc frequencies. If I conduct the masking process at 2 or 3 of those frequencies I would have enough information to refer any advisable conductive element in the loss or any Left / Right differences in the bc results.

If neither of these were evident, then the omission to mask at 4000Hz would not miss an advisable condition, give me any further relevant information regarding the loss, nor adversely affect the programming of any hearing instruments. Therefore it may be appropriate not to conduct the masking process at that one frequency as long as I enter this in the client record and detail my reasoning behind it. So I have “modified my approach to meet the needs of an individual” – but I could have done the same thing under the old rules!

Although I technically may have breached the HAC Code of Practice, the due care and attention I have delivered to my client, together with the correct client notes detailing why I had deviated would, I suggest, have been acceptable – so where’s the difference? The omission of an audiometric procedure with no explanatory notes would suggest that

code of practice

I had no awareness of the procedure being required in the first place – quite another matter altogether of course!

Previous contributors to this publication have even suggested there may be occasions when bone conduction testing could be avoided, especially if the case history, otoscopy and tympanometry suggested no dysfunction of the middle ear. While I can completely accept the thinking behind this, we need to consider the reality. Not every dispenser has a tympanometer nor might use it for every client. Bone conduction testing takes only a few minutes to perform and if the vibrator is properly and professionally sited is a far less invasive test than the pressure changes experienced in the ear canal with tympanometry. When dealing with a new client, bone conduction testing is the simplest and easiest way to prove a Sensorineural hearing loss and (with masking) to identify audiometric advisable conditions.

The HPC gives us more freedom to act in a more autonomous fashion, while still caring for our client professionally and with the correct care and attention… it is essential that the profession can demonstrate completely the ability to regulate itself.

It has never been within the scope of practice of a HAD to diagnose the cause of the advisable conditions – they are conditions requiring referral to the medical profession for diagnosis and treatment. I can see that if no change is found in the air conduction testing of an existing client, then carrying out a bone conduction test would provide little or no additional information – as long as this was noted in the client record. I can think of very few other occasions when bone conduction testing would not be a required.

The HAC may have believed the Code of Practice forced dispensers to act in a professional manner all the time.

The HPC gives us more freedom to act in a more autonomous fashion, while still caring for our client professionally and with the correct care and attention.

However in the absence of ‘legal’ obligations it is essential that the profession can demonstrate completely, the ability to regulate itself with the guidance of the professional body. If we go too far down the road of cutting corners from what were previous legal obligations just because there are no explicit legal obligations then we are in danger of seriously undermining ourselves.

The October Which? report highlighted shortcomings in those surveyed in relation to case history questioning, levels of audiometric testing and medical referrals. Whilst it could be argued that the sample of the survey was relatively small in relation to the total number of dispensers on the register, the importance of the findings cannot be denied.

Even if the survey had been conducted a year ago, the results may well have been the same. I am not suggesting that the introduction of the new regulator has suddenly reduced our standards. However, if we start to accept that any drop of standards, or the bending of previously held standards is in any way acceptable, then we are wrong. When I say ‘standards’, this should not just apply to audiometric procedures but to everything we do.

With the guidance of BSHAA and the HPC we should be actively looking to build and improve standards in every aspect of our role as dispensers.

The BSA Recommended Procedures may well be ‘only recommended’ but they have served the profession well in the past, guiding us in the correct processes we should adopt in all our practical skills. We should now be using them to enhance our professionalism, with complete and accurate client records to explain any sensible deviation from them. Not looking for ways of deviating from standards – just because we think we can!

Hugh B.Crawford is a Registered Hearing Aid Dispenser and training support specialist with Hidden Hearing and a member of BSHAA.

High Crawford

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opinion

The recent Which? magazine report and the involvement of the RNID has certainly angered a lot of BSHAA members who’re critical that such a small mystery shopper sample should be so damning of the whole private sector.

The Society’s view remains that its response should be proportionate. Member David Mould sent us a copy of a letter he penned, but later decided not to post: but BSHAA News believes it sums up the feelings and mood of most of our members perfectly.

An open letter to the Editor of Which? magazine and the RNID

by David Mould Sir, My name is David Mould. I am passionate about helping people to hear, something that I have proved I am very good at. Having qualified with and worked for three of the larger national hearing companies, I decided to set up my own business, fit2Hear in July last year and we began trading from the North Staffordshire practices of Nusyte Opticians October 2009.

when hearing aids are purchased as a pair. We publish our prices on our web site. We help our customers to choose hearing aids that are suited to their hearing needs and budget.

We never put people under pressure to make a decision.

When an urgent service visit is required, we always try to respond within 48 hours (to date, we have been successful).

We operate a highly ethical and caring hearing practice.

Gaining the qualification was much tougher than attaining my Business Studies Honours degree but I am now a Hearing Aid Dispenser registered with the Health Professions Council (HPC), our regulator. As an RHAD I am required to maintain set standards of continual professional development for both the HPC and the British Society of Hearing Aid Audiologists (of which I am a member).

These are tough times to start any business, yet alone a business where our main competitor, the NHS, gives away hearing aids and has been reducing their waiting lists and improving their instruments! Though our first year has been tough, it has been very rewarding; the greatest reward being the satisfaction of our customers. For 15 months my partner and I have worked pretty much 24/7 and we have just broken even, with most of the profit being re-invested to improve the quality of our services.

I chose to set up my own hearing company, firstly because I do not believe that this work should be driven by commercial targets and secondly because I believe that I can contribute to society and mankind whilst earning a satisfactory living. I detest the view that dispensing hearing aids is a selling profession and the notion of selling hearing aids as every “No.”, being one more “No”, closer to a “Yes”.

We offer FREE hearing tests, as do most of our private hearing company competitors, though we do charge £30 if the customer wishes to retain a copy of their audiogram record card. Our hearing aids start at just £290 for a custom made ITE and go up to £2,345 each. We always give a discount

Imagine then discovering at the turn of our first birthday, that the RNID (an organisation which we support and for which we have a huge respect) together with Which? magazine has published an article which will do immense damage to our industry is misleading, wildly inaccurate, but also does a disservice to the RNID and its benefactors.

In the UK we are exceptionally fortunate to have such a wonderful institution as the NHS, though it does have its flaws. Were it as we would all like it to be, there would be no markets for private health insurance, private medicine

BSHAA NEWS | WINTER 2010 31

opinion

and clinics, or indeed private hearing care. Sadly the NHS does not fulfil all the hearing needs of the nation and consequentially there is a gap in the market. As with any market gap, there will always be people with genuine good intentions who want to fill it. As with any other sector (including the media) there are people and organisations who we would prefer were not in our industry; however the large majority of us are passionate, caring, trustworthy, knowledgeable and very talented.

According to the Which?/RNID article, 12 researchers have visited 28 dispensers and undergone the initial consultation.

Since there is no mention of purchasing a hearing device or satisfaction with the after service received, we can only deduce that the RNID/Which? are comparing private hearing services with the NHS on the basis of the first consultation alone.

Your report stated that “no company was good enough to recommend over all” suggesting that there are no credible private hearing companies. This is very damming of the private hearing aid sector in general. It will undoubtedly have long-lasting ramifications and will most likely damage businesses like ours that are genuine, passionate and caring rather than those individuals and organisations who are the subject of the report who will simply become more ruthless to overcome its effects.

Your report states “Yet on 47% of visits, there was external noise including building work and a phone persistently ringing, instead of a sound proof booth” and later you advise, “The hearing assessment should be held in a sound proof booth. If it isn’t, go elsewhere”.

Qualified RHADs perform audiometry to the British Society of Audiologists (BSA) standards which state: “In general, the ambient noise should not exceed 35 dB(A). If it is higher than this, it is recommended that audiometry should not proceed”.

There are both benefits and disadvantages from testing in a booth. Audiometric testing to BSA standards ensures that once a hearing threshold has been found; it is re-tested at least twice to ensure that the finding is correct and not influenced by transient sounds. It is not difficult for an experienced RHAD to test and obtain accurate results between transient sounds such as phones ringing.

Experienced RHADs will instinctively know when a test response is dubious and retest thresholds wherever necessary.

I have more than once been informed that only a few of the NHS’s audiologists practice audiometry to BSA standards and the majority of NHS audiologists do not have time to follow BSA procedure or understand the benefits. Would it then be unreasonable to assume that your unnamed “expert” who advises, “if the hearing test is not conducted in a sound proof booth, go elsewhere” is an NHS expert who believes they know better than the BSA? Some so called ‘sound proof booths’ are no more than chipboard boxes with an internal seat and a saloon style door that is open at the top and the bottom. Such a booth offers no acoustic benefit. Would your expert suggest that my clients should go elsewhere, maybe to a practice with such a booth? My client is unlikely to get better clinical screening, better care, better advice or better value elsewhere, but they might get the luxury of being tested in a box!

32 BSHAA NEWS | WINTER 2010

There are also some excellent acoustic booths available and absolutely essential for anybody performing audiometry for example in a large noisy department store for example.

These booths are extremely expensive; we have calculated that it would cost us in excess of £60,000 to fit all of our practices with booths and in at least half there would be no room anyway. Imagine what it would do to our overheads if we were to replace these practices with purpose built hearing practices? If we were to invest in such booths, it is our customers who would ultimately foot the bill!

There are many more caring RHADs like myself who would like to set up small independent practices offering levels of care and value that cannot be matched. Insisting on soundproof booths would effectively create a market barrier and reduce competition; that would certainly not be of benefit to the consumer.

With regard to your criticism of the hearing practice that has a building site situated next to it; we at fit2Hear are also in the unfortunate position of having a building site located opposite one of our consulting rooms.

There have been a couple of occasions where hearing tests have been booked at a time when the noise from the site was not just transient but continual. On such occasions, I have informed my client that the test results will be close and a good indicator of any problems, but cannot be taken as accurate; on the occasion that aids were prescribed, the hearing thresholds were re-tested. Most sensible hearing aid audiologists would do the same.

By stating “Our experts said: ‘It is vital this (wax and skin debris removal from the ear canal) is removed by specially trained staff, such as those working in an ear nose and throat hospital department’”, suggests that RHADs are not qualified to carry out this procedure. I can assure you that some RHADs are qualified to do this. This same “expert” advise people to ask if the dispenser is suitably qualified to remove wax and debris; did this same expert ask if the dispenser was qualified to remove the wax from their ear? The wording of your article suggests they did not ask the question they now advise others to ask. If that so called “expert” is aware of the dangers of removing debris from the ear canal, why would they allow a novice to perform the operation?

You state, “…the cost of batteries was not discussed – they cost about £25-£45 per year per aid.” Our best selling hearing aid takes a size 13 battery, which lasts approximately 3 weeks if the aid is worn all day. We sell these batteries for £2 per packet of 6. Therefore a one year supply of batteries from fit2Hear would cost approximately £6; hardly worth discussing during an initial consultation where a great deal of information has to be obtained and imparted with. (How on earth did RNID/Which? arrive at a figure of £25-£45 per year per aid?). If I were considering dispensing an aid which requires size 5 batteries (only to be expected to last approximately 5 days), obviously I would discuss the price of batteries and then it would be in the region of £25 per aid per year, the RNID/Which? lowest estimate!

You state that “…NHS (hearing aid) models are more mid-range, but offer great sound quality…” When I dispensed for the NHS (just 2 years ago), we were fitting basic 2 channel behind-the-ear hearing aids. Private hearing company entry level products usually range from 4 to 6 channels, our mid

opinion

range 8-20 channels and our top level 20+ channels. All of the NHS hearing aids that I have seen recently are standard BTEs, with standard ear hook, standard tube and large ear mould even where a more discrete open fit would be most appropriate.

We don’t describe these as “ugly” though I can understand why some dispensers would; but they are certainly not discrete. What I do know is that by far the easiest people to sell hearing aids to, are those who have had bad experiences with recently fitted NHS hearing instruments.

They often complain that ‘all they hear in a restaurant is the clatter of plates or cutlery’, or in noisy situations they can hear a person who is whispering and sitting across the room better than the person who is sitting directly opposite them and talking in a normal voice. Most have only been fitted with one hearing aid when two would have been far more suitable. One new client had a pair of NHS hearing aids but was only wearing one. She said she could not fit the other in her ear and when I looked, it was clear the custom earmould was not made for her but for somebody else with a very large ear canal!

I still see many people who have ‘been on the NHS waiting list for years’ or have seen their GP about their hearing problems only to get responses such as ‘you can hear me, can’t you?’. I recently attended an NHS hearing aid fitting with a person who asked me to be their support, (I did not reveal to the hospital specialist that I am a private hearing aid dispenser). The lady who carried out the fitting was clearly knowledgeable and professional; the procedures she followed during the fitting were obviously NHS standards.

I heard the instrument being tested in a test box prior to the fitting, real ear measurements (REMs) were taken, (REUR, REOR, and REAR). I have no idea what acclimatisation levels were used or prescription formula. The patient was showed how to put the aid in his ear and how to change the batteries.

No expectations were set. His follow up visit was arranged for 6 months time. Little wonder then that this hearing aid became another ‘in the drawer’ NHS statistic.

Another person I know was struggling hearing in background noise. Because he had a hearing loss in both ears, I advised that he required a hearing aid in each ear (binaural squelch) to overcome these difficulties. He went back to the very same hospital department where he was told that one hearing aid was adequate for his needs. Though not good, these experiences of NHS hearing aid fitting were vastly superior to the experiences of a friend who lives in South Hams just 12 months ago, his NHS hearing aid was posted to him, (I kid you not)!

Finally and by far the worst example of how poor NHS hearing provision can be is the story of a 12 year-old boy who was brought to me recently by his worried mother. He had been to 3 ENT appointments in a South Yorkshire Hospital only to be advised that there wasn’t a problem with his hearing and discharged. My test revealed a unilateral, symmetrical, mild to moderate, sensorineural hearing loss.

Since the parents could not afford to buy hearing aids for him, I have given him a pair of my ex demonstration RICs. Since then, his attention, enjoyment and performance at school have increased noticeably.

The NHS does a great job considering their budget and time constraints; however, we in the private hearing sector can offer more time to explain what the hearing loss is, how it is affecting their speech intelligibility, what hearing options are available matching budgets and needs, setting realistic expectations from the instruments, rehabilitation support and advice.

We encourage our customers to let us know if they are having the slightest of difficulties and we maintain regular contact with them to ensure that they are getting the best possible benefit from the instruments. All get the same level of care and support regardless of how much they pay.

Your article also states: “one researcher with poor hearing in one ear would have benefitted from an aid which took the sound from that ear to the ear with better hearing”. What tosh! The system in question is called a bi-cross system. A bi-cross system is used to transfer the sound signal from the side of the head with a totally deaf ear to an ear with some hearing ability. Where one ear is poor and the other ear good, the obvious solution is to aid the poor ear. Even in a case where the client has a totally deaf ear and an ear with some hearing ability, I would not necessarily recommend a bi-cross system at the first consultation because their success rates are known to be limited.

So, in conclusion I fear my business could easily fail to meet the satisfaction of your so called “experts”, since we do not have acoustic booths and am unlikely to recommend bi-cross systems at the initial consultation. I admit we also often refer to NHS aids being large and indiscrete.

However the opinions of your un-named “experts” with their unstated qualifications and unstated professional development portfolios are worthless once the credibility of these comments is examined. The written article is inaccurate, misleading, gives poor advice and is more worthy of the gutter press than an august (reputable?) publication; yet despite this because the general public will know no better and consequently, will trust your opinions, the article is likely to have long-term, very damaging consequences for employers and employees in the private hearing aid industry in general, and ultimately the private hearing aid consumer.

David Mould

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marketing matters

Treat every customer as if they were a mystery shopper

by David Peel

’ve just come up with what I think might be a new business opportunity for Peel Media: I’m going to start selling smart displays signs for the whole of the retail sector. Their message will be intended for the front of house staff and they will say simply: “Treat every customer as if they were a mystery shopper.”

I

public should avoid an RHAD with no sound booth; I accept the valid criticism of the suggestion that a patient should have been offered a bi-cross system and I also accept the lack of clarity about what went on when ear wax was removed: did the researcher ask the question the article now says every member of the public should ask before an RHAD offers to perform clinical ear care.

It really is obvious, but like most things only after we have left open the stable door and the horse has gone for good. You see, I believe the black undercurrent in the Which? magazine report has largely gone unnoticed (or ignored) in the bluster to point out the inaccuracies, errors and misleading statements that the magazine’s quality control, perhaps aided by the RNID, have slipped into print.

We will never know for sure until either Which? magazine or the RNID offers up for scrutinty the evidence that it collected. However none of this should obscure that it appears some RHADs failed to ask the right questions, missed a referable condition, unprofessionally criticised the NHS and then there is the question of that dead ear!

I know and have heard enough now (even as a lay person) to realise the significance of the false claim that the

Before you all mass outside my office to stage a student like demonstration, let me explain that I’m not recounting

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the sorry tale of woe to make anyone feel any worse than they probably already do I simply want to make the point, probably made even more strongly elsewhere in this magazine, that as a regulated profession it behoves every single member of this Society to treat every patient that they see as if they were a mystery shopper.

In another life I fought hard against what I called at the time the “nonsensical collation of statistics in a list mad organisation” so I never thought I would hear myself say this BUT maybe there is some merit in having a check list. Any busy professional knows the job they have to do and exercises judgements in doing it, but it is much easier to make sure you have missed nothing or have noted why you have not taken a particular course of action if you have a list that you have to work through with every new client.

marketing matters

All this brings me neatly to issue of the importance of patient records from a marketing perspective. There is a mass of anecdotal evidence in the public domain about hearing loss and more pertinently about what drives people to finally seek help with it.

The hearing aid manufacturers, through their body the British Hearing Aid Manufacturers Association will soon be publishing the results of a major survey of attitudes to hearing loss on a national basis, but it strikes me that the person who will have the information most pertinent to you IS you!

Hand on heart how thorough are you about asking each client for enough information about themselves so that when you add it to a database you can use it to inform the decisions you make about your business?

I’ve often asked the question and usually get the answer “oh, I’m very thorough”. But when I dig a bit I usually find the answer really should be “I only collect skimpy information”.

So, for example, most practitioners ask why a new patient chose to use their services they are happy with the reply: “I saw an advertisement”. In fact if you have only ever advertised once that is fine, but if you regularly advertise and advertise in various publications, you have to ask “where did you see the advertisement”.

Without this information how can you

decide which advertising medium is working best for you.

But advertising is only part of it. If you ask enough questions over a long enough period of time you have a valuable piece of research which you can use to inform your business decisions, and from time to time use to generate publicity in the news columns of your local press.

What sort of questions? You probably ask them already but because they probably come within the history taking part of your consultation it perhaps never occurs to you to catalogue them in a way that allows analysis.

How long have you been aware of your hearing loss? What made you decide to do something about it? Has your hearing loss affected relationships?

Work? Family? Have you been to see your GP? What did he or she say about it? Have you been to ENT for a consultation? What was the outcome?

All these questions asked of and answered by sufficient patients over time will provide useful information to you.

The worrying thing is that when I start to think about how you manage this information (and I know that time is precious for all audiologists) I come back to this list thing. It seems to me setting up a list of what you ask each client during your consultation with a

space for their reply is a sure way of remembering to ask and having evidence of it should it ever be needed.

The list with the answers can be added anonymously to a central database by whoever does your administration (sorry if that’s you) and if it is set up correctly doing the number crunching is fairly straightforward.

Ok I can hear one or two of you saying that all this is a bit over the top.

You may be right but ponder this.

What if we could ask those unamed dispensers spoken to by researchers from Which? during those 28 infamous visits, and who were subsequently accused by Which? of failing to ask the right questions: what would they say?

David Peel, Peel Media

My Checklist

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recruitment & classified advertising

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recruitment & classified advertising

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recruitment & classified advertising

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recruitment & classified advertising

BSHAA News 2010/11 Advertising Copy Dates: 25 February 2011 for issue published SPRING 2011 17 June 2011 for issue published SUMMER 2011 19 August 2011 for issue published AUTUMN 2011 25 November 2011 for issue published WINTER 2011

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