Annual Report - Outcome 7 – Hearing Services

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Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 7 aims to provide eligible Australians with access to affordable hearing services through the Australian Government Hearing Services Program. It also focuses on reducing the incidence of hearing loss and the consequence of hearing loss for eligible Australians. The Department worked to achieve this outcome by managing initiatives under the program outlined below.

Program Administered Under Outcome 7 (Program Objectives in 2008–09)

Program 7.1 – Hearing Services

Fund hearing services and devices under the voucher system and the Community Service Obligations components of the Hearing Services Program.
Support hearing loss research and prevention.

During 2008–09, the Department managed funding for hearing services through the Government-owned provider Australian Hearing and a national network of private hearing service providers, which deliver services through a voucher system. Vouchers can be exchanged for hearing devices and services at a provider of the eligible recipient’s choice. Examples of eligible recipients include: Australian Pension Concession Card holders; people with an Australian Gold or White Repatriation Health Card with a hearing loss; and Sickness Allowance recipients¹. Funding was also provided to Australian Hearing for special needs clients covered by Community Service Obligations arrangements. In addition, the Department supported research and prevention projects funds under the Hearing Loss Prevention Program.

This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 7 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 7 was managed in 2008–09 by the Regulatory Policy and Governance Division.

Major Achievements for the Outcome:

Increased the transparency and accountability of the Community Service Obligations component of the Australian Government Hearing Services Program, by ensuring improved reporting requirements in the negotiation of a new Memorandum of Understanding with Australian Hearing (see Increased Support and Access for Special Needs Clients); and
Improved the range of hearing aid features available to eligible clients under the free-to-client arrangements by negotiating a new Deed of Standing Offer with hearing aid manufacturers and distributors (see Improving Outcomes for Hearing Services Program Clients).

A Challenge for the Outcome:

The low utilisation of the rehabilitation service for new clients, which resulted in most clients not receiving the envisaged services to help them to adjust to life with a hearing loss and to effectively use their hearing devices (see Improving Outcomes for Hearing Services Program Clients).

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Key Strategic Directions for 2008–09 – Major Activities

Improving Research and Prevention Efforts that Focus on Reducing Avoidable Hearing Loss

It is estimated that one in six Australians are affected by hearing loss and this is strongly related to age. With the ageing population, it is predicted that by 2050, one in four Australians will be affected by hearing loss. Through the Hearing Loss Prevention Program, the Department supports research and prevention projects to help reduce the burden and incidence of hearing loss in young people, Aboriginal and Torres Strait Islander communities, and those in the workplace.

In 2008–09, the Department implemented the first round of research projects under the program, funding six research projects: three that are looking at hearing loss among young people and the impact of leisure sound exposure as a source of hearing loss; two Indigenous research projects that are focused on reducing the hearing-loss related impact of otitis media on this group; and one project which is examining barriers to the better management of noise exposure in the workplace.

The Department also conducted a funding round for prevention projects. Four projects were funded in 2008–09. Three were looking at activities and strategies to reduce young people’s excessive exposure to leisure noise and one was focusing on prevention activities related to hearing loss amongst Indigenous children. During 2009–10, the Department will run a workshop for interested groups before a call for a second round of prevention projects.

Funding for the above activities was sourced from Program 7.1 – Hearing Services.

Key Fact for 2008–09: Hearing Awareness Week – ‘One in Six – its more common than you think’

Hearing Awareness Week is coordinated by the Deafness Forum of Australia. The theme of Hearing Awareness Week in 2008 was ‘One in Six – its more common than you think’. Taking place in the week commencing 24 August 2008, the aim was to raise awareness of hearing loss, and to assist and support affected people. It was to also educate the general public about reducing the incidence of hearing loss, and about measures that can be taken to improve quality of life.

Hearing Awareness Week also provided the opportunity for people to gain information about available services, and access free hearing screenings at many hearing centres around the country.

Increased Support and Access for Special Needs Clients

Under the Community Services Obligations component of the Australian Government Hearing Services Program, the Department funded Australian Hearing to provide services to children, eligible Indigenous Australians and eligible adults with complex hearing needs. While these special needs clients received the same services provided to voucher clients, they also received additional services that addressed their specific requirements. A major achievement this year was the finalisation of a Memorandum of Understanding between the Department and Australian Hearing which has brought about a higher level of transparency and accountability to the Community Service Obligations arrangements through improved reporting arrangements. This will help ensure that special needs clients receive a high standard of care.

Indigenous Australians

Indigenous Australians are eligible for services under the Community Service Obligations if they are under 21 years of age, over 50 years of age, or participants of the former Community Development Employment Projects Program. In 2008–09, the Department supported Indigenous Australians’ access by funding Australian Hearing to deliver services to outreach sites. Australian Hearing visited 221 sites, which exceeded the target of 139. This is an increase from 217 sites visited in 2007–08.

The Department also funded services such as individual hearing assessment and rehabilitation programs as well as community education and information sessions on the causes and effects of hearing loss for Indigenous Australians over 50 years of age and participants in the former Community Development Employment Projects Program. The number of people to receive services in 2008–09 was 2,526 out of a target of 2,650. The shortfall was largely due to some clients losing eligibility to the program associated with the cessation of the Community Development Employment Projects Program. Nonetheless, the number of people receiving services has continued to grow, for example, 2,293 people received services in 2007–08, compared with 2,048 people in 2006–07.
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Figure 2.3.7.1: Number of Australian Hearing Specialist Program for Indigenous Australians Sites

Source: Department of Health and Ageing program data.

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Children

Children and young people with hearing loss under 21 years have access to free hearing services through Australian Hearing. Ensuring the needs of children with hearing loss are met is important so that they can fully benefit from educational and social development opportunities. In 2008–09, the Department supported the Community Services Obligations program to provide FM system upgrades for children, and to upgrade, repair or maintain speech processors associated with cochlear implants.

In 2008–09, there was a strong growth in the number of children accessing services under the Community Services Obligations program: Australian Hearing exceeded its target of 26,260 children, providing services to 28,710 children, including 5,372 Indigenous children. This can be compared with 28,100 children in 2007–08 including 4,935 Indigenous children. Australian Hearing aims to meet the target of 26,400 children in 2009–10.

Eligible People with Complex Needs

The Department also provides additional support to adult clients who have profound hearing loss and communication difficulties. In 2008–09, Australian Hearing delivered services to 16,369 adults with complex needs under the Community Service Obligations program. During 2009–10, the Department will provide funding for a target of 20,000 clients with complex rehabilitation needs.

Funding for the above activities was sourced from Program 7.1 – Hearing Services.

Improving Outcomes for Hearing Services Program Clients

The Australian Government Hearing Services Program provides eligible clients with access to a range of free services, to help determine and manage any hearing loss. These services include a hearing assessment, the provision of a free-to-client hearing aid or other device if required, and guidance from a hearing services practitioner on how to get the maximum benefit from their hearing aid (see www.health.gov.au for full details). In 2008–09, the Department worked to improve outcomes for Hearing Services Program clients through a rehabilitation service for new clients.

Rehabilitation Service for New Clients

In 2007–08, the Department introduced the Rehabilitation Plus service item to the Hearing Services Program, to help new clients develop skills to maximise their communication abilities and use their devices effectively. This service is an extension of rehabilitation that begins when a client is first assessed and continues through fitting and follow up appointments. It allows for two additional rehabilitation sessions which clients may access either on an individual basis or in group sessions.

In 2008–09, 2,094 clients took up Rehabilitation Plus services, exceeding the target of 1,135. Achieving the targets of 4,540 to 13,620 between 2010–11 and 2012–13 is likely to be a challenge for the Department. As a result, the Department is consulting with providers to identify barriers to greater utilisation; and will closely monitor the rate of voluntary participation. The Department will also engage with relevant approved professional bodies to provide continued education to providers and clients on the benefits of rehabilitation.
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Improved Quality of Devices

The Department worked to make sure that free-to-client devices provided through the Hearing Services Program reflect the ongoing developments in hearing aid technology, and meet clients’ needs. A major achievement was the negotiation a new Deed of Standing Offer with hearing device suppliers, in which the Department ensured that clients will receive improved, high powered Behind The Ear hearing aids, non-standard devices and alternative listening devices under free-to-client arrangements.

For example, the minimum specifications for Behind The Ear devices require switchable or adaptive directional microphones, feedback cancellation and one form of noise reduction. Also, the hearing aid minimum specifications require these devices to include at least one of a list of automatic features such as transient noise reduction, auto phone, an automatic directional microphone or wireless connectivity.

The new Deed commenced on 1 April 2009 and established a six month transition period to the new device specifications, with all obsolete devices to be removed from the schedule of approved devices by 30 September 2009. The Department will monitor this requirement over 2009–10.

Funding for the above activities was sourced from Program 7.1 – Hearing Services.

Improved Provision of Services under the Hearing Services Program

In 2008–09, the Department focused on improving access to the Hearing Services Program, through a revised clinical pathway which aims to reduce delays in voucher applications and referrals, and put in place appropriate checks and balances to achieve safety and quality outcomes for clients.

Throughout 2008–09, the Department sought feedback through meetings, Clinical Pathways e Bulletins (available at www.health.gov.au) and by writing to every qualified practitioner in the program. The Department will work to finalise and implement the new clinical pathway model in 2009–10, which will then be presented to stakeholders through a series of public meetings.

Funding for the above activity was sourced from Program 7.1 – Hearing Services.
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Performance Information for Outcome 7 Administered Programs

Program 7.1 – Hearing Services
Indicator:	Increased level of access to hearing services by eligible clients through the maintenance of, or addition to, the number of sites registered to provide audiological services under the Hearing Services Program.
Reference Point/Target:	1,900 registered sites in 2008–09.
Result: Indicator exceeded.
As at 30 June 2009, 2,037 sites were registered under the Hearing Services Program. This compares with 1,963 sites in 2007–08 (a 4% increase), and 1,813 sites in 2006–07.
Indicator:	Clients benefit from the Hearing Services Program. Measured by the number of clients that access services, including clients eligible through the new expanded access measures.
Reference Point/Target:	510,000 clients receive services in 2008–09.
Result: Indicator exceeded.
A total of 541,883 clients accessed Voucher and Community Services Obligation services in 2008–09. This compares with 498,555 clients in 2007–08 (a 5.4% increase), and 480,728 clients in 2006–07.
Indicator:	Maintenance or increase in the proportion of fitted clients who use their device/s for 5 or more hours per day. Monitored by the annual Office of Hearing Services client survey.
Reference Point/Target:	56% of clients use their devices for 5 or more hours per day.
Result: Indicator met.
The results of the client survey undertaken in July 2008 found that 60.4% of fitted voucher clients (estimated at 263,456 clients) used their device for more than 5 hours per day. This measure indicates the proportion of fitted clients who gain a significant benefit from their devices.
Indicator:	Timely issuing of vouchers to eligible clients. Measured by application processing statistics.
Reference Point/Target:	On average, eligible clients are issued with a voucher within 14 days from receipt of a correctly completed application.
Result: Indicator not met.
At the end of June 2009, the overall average processing delay was 14 days. However for five months of the 12 measured, the average delay was outside the target. The Department did not meet the timeframes in its Client Service Charter, primarily due to substantial increases in voucher requests and calls received via the Hearing Services Information Line within the Department’s Office of Hearing Services. Voucher requests rose by more than 22% to 299,304 in 2008–09 (compared with 244,883 in 2007–08). The number of calls received increased by more than 20% to 108,147 calls (compared with 87,025 in 2007–08). During 2009–10, the Department will review its administrative processes to deal with this increasing workload, and to ensure that clients receive vouchers in a reasonable timeframe.

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Figure 2.3.7.2: Voucher Applications Received and Vouchers Issued

Source: Department of Health and Ageing program data.

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Performance Information for Outcome 7 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:	Quality, relevant and timely advice for Australian Government decision-making, measured by ministerial satisfaction.
Reference Point/Target:	Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:	Production of relevant and timely evidence-based policy research.
Reference Point/Target:	Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
Expert opinion was sought from the National Acoustic Laboratories on the link between hearing aid use and the levels of hearing loss. This advice contributed to the introduction of the minimum hearing loss threshold measure which was announced in the 2009–10 Budget.

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Output Group 2 – Program Management
Indicator:	Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator not met.
The actual Administered expenses for Outcome 7 were 3.3% less than budgeted expenses. This is due to the demand driven nature of the Australian Government Hearing Services Program.
Indicator:	Stakeholders participate in program development through a range of avenues, such as surveys, committees, meetings, and submissions on departmental discussion papers.
Reference Point/Target:	Stakeholders participate in program development.
Result: Indicator met.
The Department consulted with clients, service providers, manufacturers and Australian Hearing in relation to the clinical pathway proposals and the renewal of the Deed of Standing Offer and practitioner registration matters, through meetings, electronic bulletins and invitations for feedback.
Indicator:	Routine monitoring of quality of service provision and compliance with legislation by accredited providers.
Reference Point/Target:	20% of accredited hearing service providers and 20% of qualified practitioners will be reviewed each year.
Result: Indicator exceeded.
In 2008–09, 39 site audits, six new provider audits and 385 practitioner audits were conducted representing 22% of providers and 32% of qualified practitioners. This compares with 32 site audits, 18 new provider audits and 357 practitioner audits in 2007–08.

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Outcome 7 – Financial Resources Summary

	(A) Budget Estimate 2008–09 $’000	(B) Actual 2008–09 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2009–10 $’000
Program 7.1: Hearing Services
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	319,770	309,470	(10,300)	348,931
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	9,589	9,213	(376)	9,208
Revenues from other sources	159	203	44	167
Subtotal for Program 7.1	329,518	318,886	(10,632)	358,306
Total Resources for Outcome 7	329,518	318,886	(10,632)	358,306
Outcome 7 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	2,047	1,978	(69)	1,969
Output Group 2: Program Management	7,701	7,438	(263)	7,406
Total Departmental Resources	9,748	9,416	(332)	9,375
Average Staffing Level (Number)	75	76	1	74

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1 A full list of eligibility requirements is available at the Department's website: www.health.gov.au.

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