The NHS hearing aid service

The NHS hearing aid service - About this factsheet

This factsheet is part of RNID's hearing aids range. It is written for deaf and hard of hearing people. We use the term deaf people to refer to deaf, deafened and hard of hearing people throughout this factsheet.

If you think you have a hearing loss or you are sure that you have, you have probably thought about getting a hearing aid. However, you may not know what to do next. This factsheet tells you what you need to do to get a hearing aid.

In the UK, you can get a hearing aid free from the National Health Service (NHS) or you can buy one privately. This factsheet tells you more about getting an NHS hearing aid. If you already have an NHS hearing aid, you will also find this factsheet useful since it tells you what the NHS hearing aid service can offer you. For information about buying a hearing aid privately, see RNID's factsheet, Buying a hearing aid?

At the end of this factsheet we give you details of organisations you can contact for further information.

How to get an NHS hearing aid

If you think you are hard of hearing and may need a hearing aid, the first thing you need to do is visit your GP (family doctor). You may have wax or an infection which can temporarily affect your hearing and which can be treated by your GP. Alternatively, he or she may refer you to a hospital ear, nose and throat (ENT) clinic. Here, you will be seen by an ENT surgeon and an audiologist.

Your GP may send you straight to the audiology department at the local hospital to have your hearing tested. This is called 'direct referral' and it means you will not have to join a waiting list to see the ENT surgeon first. You will still have to wait for an audiology appointment, though. In most areas, direct referral to the audiology department is only possible for people over 60 and depends on local arrangements.

Some GPs arrange for audiology staff to visit their surgery or health centre to run a clinic, so you may be able to have an assessment of your hearing there instead of at the hospital.

Your GP may need convincing about the problems your hearing loss causes. You may have to insist on being referred to a hospital for assessment. Remember that you have the right to have your hearing assessed, particularly if you feel your hearing loss is becoming a problem.

The hospital appointment

If you have been referred to an ENT surgeon, you will usually see them in a hospital outpatients' clinic. Your ears will be examined for obvious signs of damage or disease and you will be asked about your medical history.

Some hearing tests may be performed with a tuning fork. These tests can tell which ear has the greater hearing loss and the type of hearing loss. Audiology staff will then carry out further tests using a machine called an audiometer. The audiometer produces sounds of differing frequencies (pitch) and levels of loudness. You will be asked to listen to these through a set of headphones and you have to say when you hear the particular sound, usually by pressing a button. The audiology staff will record the softest sound that you can hear at each frequency. This is known as the 'threshold'. If the tests suggest you would find a hearing aid useful, the audiology staff will discuss options with you and will take impressions of your ears to make earmoulds that fit perfectly.

You should be offered two hearing aids if you will benefit more from two aids than from one, though policy about this varies from one clinic to another. Opinion varies as to how two aids should be provided. You may be given both aids at the same time, so that you start to get used to using an aid in each ear immediately, or you may be given one aid and have time to get used to it before the second aid is fitted.

You will have an appointment a few weeks after the assessment when the earmould is ready, so that you can have your hearing aid fitted. The hearing aid will be chosen to suit your hearing loss. The audiology staff who fit it will also adjust it for you, show you how to put it in, how to use the volume control and the on/off/telecoil switch, and how to change the batteries.

The audiology staff will also explain what your hearing aid can and cannot do. They may suggest ways you can get used to it, such as gradually increasing how long you wear the aid, and practising listening to different sounds around the house before trying it when you are out. You should have an appointment about six weeks after this, so that you can ask questions and sort out any problems you may be having. The audiology staff can make necessary adjustments to the earmould or hearing aid.

How the NHS hearing aid service works

The NHS buys a range of hearing aids and uses it's bulk buying power to get cheaper hearing aids from hearing aid manufacturers. The audiology departments then buy these aids and loan them to NHS patients, though they may not have every aid in the range. It is the job of audiology staff to choose the best NHS hearing aid for you.

The companies that make NHS hearing aids also supply the private sector, but NHS provision is separate from private purchase. You are still entitled to an NHS hearing aid if you buy a hearing aid privately, but you cannot get financial help from the NHS to buy an aid.

It is unlawful to sell an NHS hearing aid and they remain NHS property, so if you have one that you no longer use, you should take it back to an audiology department. If you lose or damage your hearing aid, the NHS may charge you for 'loss of property'. However, each case of such loss or damage should be assessed individually.

National Health Service hearing aids

NHS hearing aids are usually available in the following categories:

In-the-ear (ITE types)

These hearing aids are modular aids - this means they are a standard shape - connected to individually-made earmoulds. The aid and mould fit into your ear as a single unit. They are suitable for people with mild to moderate hearing loss.

Behind-the-ear aids (BTE types)

These are worn behind the ear, with sound relayed to the ear through the earmould. Three series of these aids are available on the NHS:

Those that are medium power for mild to moderate hearing loss.
Those that are high power for moderate to severe hearing loss.
Those that are very high power for severe to profound hearing loss.

Some are mini aids and others are compact or of a standard size.

Body worn hearing aids (BW types)

BW hearing aids consist of a box, a little larger than a matchbox, which you clip to your clothes, or put in a pocket or pouch. A lead connects the aid to an earphone, which is attached to the earmould in the ear. Earphones are of varying strengths to suit different degrees of hearing loss. The following types of BW hearing aids are available on the NHS:

High-powered aids, suitable for moderate to profound hearing loss.
Very high-powered aids, suitable for profound hearing loss.

Bone conduction hearing aids

These are suitable for people who cannot use a conventional hearing aid because of frequent ear infections or the shape of their outer ear. The bone conductor is held on to the mastoid - the bone behind the ear - by a small headband. It vibrates in response to sounds, transmitting them through the skull to the inner ear. These aids are available as behind-the-ear and body worn models.

An alternative type of bone conduction hearing aid is the bone anchored hearing aid (BAHA). The BAHA is attached to a titanium fixture, which is surgically implanted in the region behind the ear.

The different features of hearing aids

Automatic Gain Control (AGC): hearing aids with AGC can automatically adjust their level of amplification according to the level of sound they pick up. As the sounds coming into the aid get louder, they are amplified less. This means that sounds never become uncomfortably loud.

Frequency range: the range of frequencies (pitches) of sound amplified by the hearing aid. People's hearing loss varies and hearing aids are therefore chosen and adjusted to amplify the range of tones that each person needs to hear more clearly.

Full on gain and maximum output: full on gain is the highest amount that the aid can amplify sound by, and maximum output is the highest volume of sound that an aid can produce. More powerful aids have higher gain and output and are therefore suitable for people with a more severe hearing loss.

Peak clipping: this is another system for limiting the loudness of sounds so that they do not get to an uncomfortable level. Sounds above a certain loudness level are 'clipped' but this sometimes results in distorted sound. Aids with AGC (see above) provide better sound quality and you may prefer these.

Telecoil: a tiny device in the hearing aid that enables it to pick up an electromagnetic signal from an induction loop. For practical purposes, this means that to use an induction loop or telephone with an inductive coupler, you need to switch to the 'T' setting on your hearing aid. You should then hear the sound source much more clearly, without interference from room acoustics or background noise.

Spare hearing aids

It will not usually be possible for you to have a spare hearing aid, but policy differs from centre to centre. Whether you can have a spare may depend on various factors. For example, you are more likely to get a spare if you have a visual impairment and a very severe hearing loss, or you have a hearing loss in one ear and no useful hearing in the other.

Digital hearing aids and the NHS

England

Digital hearing aids are currently not available on the NHS everywhere in England. In January 2000, after extensive lobbying from RNID, the Government announced that it was funding the NHS to provide state-of-the-art digital hearing aids. The NHS is the largest buyer of hearing aids in the world and can use this purchasing power to obtain high quality digital aids in bulk and at drastically reduced prices. However, most audiology centres need extra staff, new equipment and training in order to provide the new service effectively. The upgrade is therefore happening in stages.

In September 2000 the first of 20 selected NHS trusts in England began to provide digital aids as part of the 'First wave' project. This was funded to run for approximately two years.
By the end of October 2001, 11,000 people had received digital hearing aids through the NHS project. About 2,000 people per month were being fitted with them.
In December 2001, the Government announced that at least 30 further sites would be fitting digital hearing aids by the end of 2002. On top of this, at least a further 15 sites will have the necessary training and equipment in place to start fitting digital hearing aids in 2003.

The eventual goal is the provision of digital hearing aids on the NHS throughout the UK.

Northern Ireland

RNID is actively lobbying for the modernisation of audiology services in Northern Ireland.

Scotland

At present just 1.6 per cent of NHS hearing aids provided in Scotland are digital. The Scottish Executive is reviewing NHS audiology services in Scotland and has provided an additional £750,000 to upgrade services in the meantime. RNID is campaigning for the Scottish hearing aid service to have a fully funded modernisation programme to bring it up to the same level as the programme in England.

Wales

The Welsh Assembly has provided £2.25 million to modernise audiology services throughout Wales, and further funding from April 2002 to provide modern hearing aids, including digital models.

What else is available?

A wide range of hearing aids is available through the NHS, so it is likely that one of them will suit you. However, if they are not suitable, a commercial hearing aid may be prescribed for you. Policy on this varies. It depends on the audiology department's financial constraints, and often on whether or not your situation meets criteria set by the ENT surgeon or head of department. Commercial hearing aids that are not part of the standard NHS range may include:

BTE, ITE and ITC (in-the-canal) hearing aids with special features. Some are self-adjusting and some have settings for different listening conditions such as a noisy environment, using the telephone, or meetings. You may be able to use a remote control to change the settings or volume. ITC aids are not suitable for profoundly deaf people.

CROS or BiCROS hearing aids are a further option for people with no hearing in one ear and normal or mild to moderate hearing loss in the other ear. CROS hearing aids feed sound from the side where there is no useable hearing into the good ear. A BiCROS aid amplifies sound from both sides and feeds it into the ear that has useable hearing.

Frequency Transposition Aids. These can be helpful for people with some hearing at low frequencies, but no hearing at high frequencies.

Noise generators (tinnitus maskers) can be provided for people with tinnitus. Please contact the RNID Tinnitus Helpline for further information (contact details at the end of this factsheet).

Patients with mild to moderate hearing loss who wear glasses can have hearing aids attached to their spectacle frames.

Personal communicators and listening devices may be issued to people who cannot tolerate or manage hearing aids. They may also be used with hearing aids.

Vibrotactile aids. These may be helpful to people who have little or no hearing in either ear.

Having your hearing aid serviced and getting new batteries

NHS hearing aids come with a booklet to keep a record of information about them such as the type of hearing aid, and when and where they were issued. This booklet proves you have an NHS hearing aid, so if you need to, you can go to any audiology department to get new batteries or check that your aid is working properly. Remember that you can go back as often as you need to if you have a problem with your hearing aid. If you think your hearing has changed, you can ask to have it tested again to see if you need a different hearing aid.

If you have an NHS hearing aid, you can get free batteries from any audiology department. Audiology staff will tell you if you can get batteries from the hearing aid centre by post, or at a drop-in clinic. At drop-in clinics, you do not need an appointment for batteries, simple repairs or earmould retubing, but they may not always be open. Some GP surgeries run battery exchange services. You can also buy batteries from any pharmacy.

If you find your hearing aid does not help

If you find it difficult to get used to your hearing aid, do not give up. Try wearing it for a few days and make a note of all the problems you have with it. Then make an appointment with the audiology department to talk to the staff there about the problems you are having. They can check whether your hearing aid is working properly. They may be able to adjust your hearing aid to suit you better. If it whistles, you may need a new mould, or you may not be inserting it correctly. Whatever happens, keep trying. It takes a while to get used to a hearing aid. If you still find that your hearing aid is not really helping, you could ask for a better hearing aid in the NHS range or for an aid for each ear if you have been offered only one aid so far.

Other ways to help yourself

Just acknowledging that you have a hearing loss and may need a hearing aid is a huge step, but it is only the beginning. You can do many other things to help yourself:

Some audiology departments have a hearing therapist to counsel you if you are finding it difficult to get used to your hearing loss or using a hearing aid, and to liaise with social services if you need other equipment. Hearing therapists may also advise you about communicating with other people. They may run tinnitus clinics and they will know if there are local support groups you can join. Whether or not you have access to a hearing therapist, your audiology department is there to help if you have problems with your hearing aid.
Contact your local social services. Ask their sensory impairment unit or the social worker with deaf people to visit you to assess your needs. They may provide special equipment such as amplified telephones or visual alerting systems for your home, or suggest other ways they can help.
Make sure your family and friends know about your hearing loss. Keep reminding them that they must make an effort to talk clearly to you. You are not being selfish or demanding - no-one wants to be left out of a conversation.
Go to lipreading classes. You will be able to learn tactics for lipreading and to practise with other hard of hearing people.
Find out if there is a local hard of hearing group you can join. Sharing experiences and listening to the suggestions of other people can be very helpful.
Try to find out if there is a volunteer visiting service in your area. Support from other people can give you the confidence and encouragement you need to keep trying with your hearing aid.