Refusing people hearing aids – a parable for Britain’s short-term health policy

http://www.theguardian.com/commentisfree/2015/feb/09/hearing-aids-health-policy-austerity-nhs

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Lend me your ears. What follows is a plea about a specific, if widespread, series of health problems; but it’s also a parable about the short-term nature of our debate on the NHS, and about value for money, investment and austerity economics.

Let’s start with a big number. There are an estimated 10 million people in this country who suffer from hearing loss. “Hearing loss” is a slightly bland, cotton-woolly phrase for the disorientation of suddenly discovering that the world is a bit further away from you than you thought: that you can’t quite grasp the passing remarks of work colleagues, or questions from your children; that the announcement systems in doctors’ surgeries or airports are baffling; that you are withdrawing from social situations again and again because they are no longer much fun.

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Because of our ageing population, these disabilities are becoming more widespread. By 2031, the 10 million will have become 14.5 million. So-called adult-onset hearing loss refers to loss caused by ageing or noise exposure – background factory noises, pneumatic drills, too much drum and bass through those headphones. It can’t be surgically repaired, it’s permanent, and only gets worse. If you don’t have it, you will – or somebody you know will. Sorry, but those are the facts.

Luckily, there are other facts. If you’re going to get this desperately upsetting problem, you are fortunate to be alive at this moment in time. Hearing aids have never been better: they are now digital, smaller than ever and highly effective. Furthermore, Britain is a world leader in the more advanced technology of cochlear implants, which are inserted directly into the brain and can deal with total hearing loss. These are getting cheaper all the time and are life changing. My father’s life was transformed by one.

There is now a formidable body of research showing that hearing loss has a huge impact on other health problems including frequent falls, depression, Alzheimer’s and even sight loss. For obvious reasons, for many people it can also mean the loss of their jobs. Of the 300,000 people of working age with a severe hearing impairment, 20% were unemployed (compared to 6.2% in the general population), and an extra 10% said they couldn’t look for work. In dry numerical terms, this is very expensive. Recent figures show that more than a third of the Access to Work budget in England and Wales was spent on people with hearing loss, costing more than £31m.

Cochlear implants cost more but can keep somebody in work or out of hospital – or both – for more than a decade

But that doesn’t begin to cover the true costs – the medical intervention needed for depressed, isolated and vulnerable people who pay more visits to their GP and who often end up in A&E. For many people, hearing loss is the beginning of a downward spiral which ends in hospital or full-time care.

A study by Action on Hearing Loss suggests that by properly managing the problem in people with severe dementia, for instance, we could save £28m by delaying their admission into residential care. The Ear Foundation also calculate that deafness results in £4bn in lost earnings, £76m in extra GP visits, and £60m in increased social care costs. At a conservative estimate, it says, the total economic cost of hearing loss in the UK is around £30bn a year. This is not just miserable for the millions of people involved; it is one of the reasons we have a so-called “NHS crisis”.

A decent hearing aid is such a small thing. Cochlear implants cost more but can keep somebody in work or out of hospital – or both – for more than a decade. You can see by now where this is all going: step forward the North Staffordshire clinical commissioning group. It decided to withdraw NHS-funded hearing aids for people with mild to moderate adult-onset hearing loss across a range of towns, until a public outcry made it put the plans on hold until after the election.

Across England other clinical commissioning groups are considering the same plan. As the austerity squeeze goes on, NHS England has launched a consultation about which specialised services and treatments to invest in, and warns that it means “we have to make difficult decisions”.

That’s one way of putting it. The Ear Foundation says: “We have seen a significant change in commissioning practice with the advent of new NHS structures in England and Wales. Requests for (cochlear) implantation are being refused due to an overall overspend.”

It’s a big moment. Since its foundation in 1948, the NHS has always provided free hearing aids. These days we need many more of them than we used to, and they are a lot better, and in relative terms cheaper too. To fail to properly screen and treat people with hearing loss is inhumane, ridiculously short term and economically nonsensical.

A relatively small upfront cost can keep someone in work, or keep them at home operating happily and successfully in the community supporting friends and family, for many years.

This is really about value, choosing to spend on curing and helping rather than binding open wounds and forking out for the consequences of not intervening. One of the problems with austerity economics is that all the focus goes on immediate, instant, short-termist “savings” rather than on keeping our nerve and asking what is right and prudent for the long term.

I promised a parable: what is happening with hearing loss – an apparently mundane and certainly very common problem facing so many of us – is that a short-term panic about budgets is producing ludicrous medium- and longer-term judgments.

So it is with much else, of course: early investment in childcare helps in avoiding later spending on the consequences of vandalism and crime; spending on mental health leads to less spending on prisons; getting stroke survivors the correct physiotherapy means they can carry on working and paying taxes, rather than depending on the welfare state.

As a time when the first question for any Labour spokesman is, “Where is the money coming from?”, this isn’t the easiest argument to win. There are so many good ways to spend public money, and so little of it about.

But for too long the debate about health spending has simply focused on immediate, short-term costs, not on real costs. There is still time before the election to put that right.