Outcome 7 Hearing Services

A reduction in the incidence and consequence of hearing loss, including through research and prevention activities, and access to hearing services and devices for eligible people.

| TOC | next page

Outcome Summary

Through Outcome 7, the Australian Government aims to reduce the incidence of avoidable hearing loss in the community and the consequence of hearing loss for eligible people, by supporting research into prevention activities and ensuring access to high quality hearing rehabilitation and devices that they need. The department worked to achieve this outcome by managing initiatives under the program outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 7 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 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 2009-10 by the Regulatory Policy and Governance Division.

Program Administered under Outcome 7 and 2009-10 Objectives

Program 7.1: Hearing Services

Reduce the incidence and consequence of hearing loss.
Support research into prevention activities to reduce the incidence of avoidable hearing loss.
Expand affordable rehabilitation services.
Improve the provision of hearing devices and services.

Major Achievements

A significant increase in the number of clients who accessed hearing services, from 541,883 in 2008-09 to 568,293 in 2009-10.
Established guidelines and regulations to implement the 2009-10 Budget measure Minimum Hearing Loss Threshold, to better target hearing devices at those with the greatest clinical need.

Challenges

Growth in client demand exceeded capacity to deliver services. This resulted in timeframes for application processing, and call centre wait times, exceeding levels set out in the Client Service Charter.
Improving, but still lower than anticipated, use of Rehabilitation Plus services.

Program 7.1: Hearing Services

Program 7.1 aims to reduce the incidence and consequence of hearing loss in Australians.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve this aim were to:

improve the quality of hearing services for eligible clients;
implement better targeting of Australian Government resources; and
reduce avoidable hearing loss.

Major Activities

Improve the Quality of Hearing Services

Clinical Pathway

In 2009-10, the department continued finalising a revised clinical pathway for clients of the Hearing Services program. Once eligible clients received a voucher for hearing services, they commenced a clinical pathway that takes them from a medical assessment through to a hearing assessment, followed by either the fitting of a hearing device or other rehabilitative services. The department undertook extensive consultations with hearing service providers, consumer representative groups and medical professional bodies to finalise the pathway. The pathway contains appropriate checks and balances to achieve safety and quality outcomes for clients. Consultations included face-to-face meetings, establishment of working groups to respond to specific issues and dissemination of information via electronic bulletins and mail outs to stakeholders, including the medical professional bodies, hearing services industry representative bodies and consumer representatives.

During consultations with stakeholders, the department agreed that the revised clinical pathway will be reviewed in the context of future changes to the hearing industry environment. Following finalisation of Ministerial approval processes, the department will implement the revised clinical pathway in 2010-11.

Rehabilitation Services

In 2009-10, the department continued to fund enhanced rehabilitation services through the Rehabilitation Plus program. Through the program, hearing service providers are supported to educate and encourage clients to make the best use of their hearing aids to help them cope with hearing loss and prevent the under-use of their aids. Service providers have been required to offer the Rehabilitation Plus service since January 2009. In 2009-10, the department worked with providers to improve the uptake of rehabilitation services by clients fitted with a free-to-client hearing device(s) for the first time. Participation by clients was voluntary, and there was less than predicted use of the service. The department expects that as service providers and clients become more aware of the benefits of the additional rehabilitation program, the rate of voluntary participation will continue to increase. However, the department will commence a review of the service in 2010-11 to determine the barriers to accessing the service and the opportunities that can be provided to improve access and uptake of services.

Improve Hearing Device Specifications

In 2009-10, the department monitored the new arrangements to obtain hearing devices for the program and the range of features for the available hearing devices has been improved. Following a six-month transition period to the new device specifications, all obsolete devices were removed from the schedule of approved devices by 30 September 2009. This ensured that all clients who were fitted with hearing devices continue to have access to the latest hearing device technology.

Better Targeting of Government Resources

In 2009-10, a major challenge for the department was a large increase in client demand for hearing services, with client numbers growing by 15 per cent, and fixed resources available for client services. This resulted in application processing delays, which were significantly higher than the program’s performance target of 14 days. The average processing time was 17.7 days, with highs up to 38 days in March 2010. Waiting times for the call centre also increased significantly to an average of eight minutes per call whereas, in 2008-09 the average waiting time was five minutes. A one-off reallocation of resources and realignment of work priorities within the department reduced the delays to clients and providers with the average call waiting time reduced to five minutes and processing time in June 2010 reduced to eight and a half days.

Minimum Hearing Loss Threshold

The department implemented the minimum hearing loss threshold on 1 July 2010. The introduction of a minimum hearing loss threshold removes access to subsidised hearing services for clients with a hearing loss of 23 decibels (dB) or below, ensuring that subsidised hearing devices are provided to those with a demonstrated clinical need. Clients assessed as not having a clinical need for a hearing device will still be eligible to receive other services to help them manage their minimal hearing loss and also manage any difficulties in communicating in different environments.

The department consulted extensively with the hearing services industry, professional bodies and consumer representative groups to develop exemption criteria. The exemption criteria means that a client who is assessed as having a hearing loss of 23dB or below but demonstrates a clinical need for a hearing device, will be fitted under the program. Approval processes for the exemption criteria and amendments to the Hearing Services Administration Act 1997 were finalised in June 2010. The department rolled out a comprehensive communication strategy regarding the minimum hearing loss threshold and the exemption criteria to the hearing industry and consumers during June 2010. This included dissemination of information through a special electronic bulletin, letters to every hearing practitioner working under the program, printed information for consumers and web based information for hearing service providers and consumers. In 2010-11, the department will monitor the implementation of the minimum hearing loss threshold through random and targeted auditing of contracted service providers and a review at 12 months.

About the Office of Hearing Services

The Australian Government Hearing Services program is run by the department’s Office of Hearing Services. The Office of Hearing Services manages the issuing of vouchers for eligible clients to access hearing assessments and devices from hearing service providers of their choice from a list of providers contracted to the Australian Government. It also administers the provision of hearing services for eligible clients with special needs such as children, Aboriginal and Torres Strait Islander people, clients in remote locations and older clients with complex hearing problems. The office oversees more than 200 contracted hearing service providers that operate in all states and territories in more than 2,000 permanent, visiting and remote sites.¹

Reduce Avoidable Hearing Loss

Through the Hearing Loss Prevention program, the department supports research to identify strategies for individuals and communities to reduce avoidable hearing loss. This program funds action research projects on potential prevention strategies that target Aboriginal and Torres Strait Islander peoples, young people and those in the workplace.

In 2009-10, the department supported research into hearing loss prevention activities and continued to monitor the progress of new and existing research projects. The research projects will fill important gaps in knowledge about effective strategies to prevent hearing loss. The management of middle-ear disease and hearing loss in Aboriginal children up to five years of age is one of the approved projects. The program also targets school-age children and young people through prevention education, and identifing opportunites and barriers to the effective control of hazardous noise exposure in the workplace. Two research projects were completed in 2009-10 – 'Getting Heard' by Safe Work Australia available at www.safeworkaustralia.gov.au and 'Using Auditory Simulations to Enable Prevention of Noise Exposure in School-Age Children and Young Adults' by Edith Cowan University.² This research will help inform Government policy on the effects of environmental noise and prevention of occupational noise induced hearing loss.

¹ Further information can be found at www.health.gov.au/hear or on telephone 1800 500 726 or telephone typewriter (TTY) 1800 500 496.

² Available at www.psychology.ecu.edu.au/staff/cv/chang_p.php.

Performance Information for Outcome 7

Program 7.1: Deliverables

Qualitative Deliverable

Improve the Quality of Hearing Services
Qualitative Deliverable:	Regular stakeholder participation in program development occurs through a range of avenues such as surveys, committees, meetings, and submissions in departmental discussion papers. Stakeholders are also supported under the program through access to a call centre, and written communication and publications to provide information about the program. The 2009 Client Satisfaction Survey is due to be published by February 2010.
Result: Deliverable substantially met.
In 2009-10, the department consulted with clients, the hearing services industry, hearing services and medical professional bodies and consumer representative organisations in relation to the clinical pathway proposals, the Minimum Hearing Loss Threshold and practitioner registration matters, through meetings, electronic bulletins and invitations for feedback. A specific information technology forum for service providers, which met regularly, was also established to look at information technology issues and further system improvements. The Client Satisfaction Survey was reviewed for purpose and content, leading to the development of a new survey instrument. As a result of this activity, the conduct of the survey was delayed until June 2010.

Quantitative Deliverables

Improve the Quality of Hearing Services
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.8%
Result: Deliverable substantially met.
The Australian Government Hearing Services program is a demand driven program. In 2009-10, the variance between actual expenses and budgeted expenses was -0.8 per cent. The variance reflects the demand driven nature of the program.
Quantitative Deliverable:	Number of sites registered to provide services under the Hearing Services program.
2009-10 Target:	2,000	Actual: 2009-10	2,131
Result: Deliverable met.
As at 30 June 2010, there were 2,131 sites registered under the Australian Government Hearing Services program. This compares with 2,037 sites in 2008-09 and 1,963 sites in 2007-08.
Quantitative Deliverable:	Number of people receiving hearing services.
2009-10 Target:	572,224	Actual: 2009-10	568,293
Result: Deliverable substantially met.
A total of 568,293 clients accessed Voucher and Community Service Obligations services in 2009-10. This compares with 541,883 clients in 2008-09 and 498,555 clients in 2007-08.
Quantitative Deliverable:	Number of clients accessing rehabilitation services.
2009-10 Target:	2,270	Actual: 2009-10	3,154
Result: Deliverable met.
The number of clients accessing rehabilitation services in 2009-10 was 3,154. This exceeds the expected rate by 884 services and is a result of promoting the services to the service providers.
Quantitative Deliverable:	The percentage of contracted service providers audited to ensure the quality of service provision and compliance with legislation.
2009-10 Target:	20%	2009-10 Actual:	17%
Result: Deliverable substantially met.
During 2009-10, the department moved from cyclical audits to targeted risk-based audits. Consequently, the 2009-10 target was substantially met with 17 per cent of contracted service providers audited.
Quantitative Deliverable:	The number and percentage of qualified practitioners reviewed and/or monitored to ensure the quality of service provision and compliance with legislation.
2009-10 Target:	269 (20%)	2009-10 Actual:	450 (34%)
Result: Deliverable met.
In 2009-10, 450 qualified practitioners were reviewed, representing 34 per cent of all qualified practitioners. This compares with 385 practitioner audits undertaken in 2008-09.

Top of page

Program 7.1: Key Performance Indicators

Qualitative Key Performance Indicator

Improve the Quality of Hearing Services
Qualitative Indicator:	Consultation with providers regarding their direct experiences in the delivery of rehabilitation services, and their assessment of the level of confidence with which they deliver these services, will provide a qualitative measure of how well providers are delivering this service. This will be matched with feedback from consumers obtained through client surveys.
Result: Indicator substantially met.
The department completed consultations with service providers to collect feedback and provide advice on the delivery of rehabilitation services. While, as a result of this activity the uptake in Rehabilitation Plus increased, uptake is still low and the program will be reviewed in 2010-11.

Quantitative Key Performance Indicators

Improve the Quality of Hearing Services
Quantitative Indicator:	Average number of working days taken to issue vouchers to eligible clients.
2009-10 Target:	14	2009-10 Actual:	17.7
Result: Indicator not met.
Due to the increases in the number of voucher requests received and the number of calls made to the Hearing Services Client Contact Line, the average processing time was more than the target of 14 days. The average processing time peaked at 38 working days in March 2010. The department managed to reduce the average processing time to 8.5 days by June 2010. The rate of increase for voucher requests in 2009-10 was 13.7 per cent. This trend continues from 2008-09 and 2007-08 where, in both years, this indicator was not met. In 2009-10, the department commenced a review of its administrative processes and as a result, redirected resources to applications processing to enable it to better meet published targets.
Quantitative Indicator:	Increased usage of hearing devices for the Rehabilitation Plus population compared with clients who have not received these services (commences July 2009).
2009-10 Target:	60%	2009-10 Actual:	57%
Result: Indicator substantially met.
Use of hearing devices for the Rehabilitation Plus population was not as high as estimated. A survey of providers’ views and perceptions on Rehabilitation Plus will be undertaken in 2010-11. Trend data cannot be reported for this indicator as it was a new indicator for the 2009-10 Portfolio Budget Statements.
Quantitative Indicator:	Maintain or increase the percentage of fitted clients who use their device(s) for 5 or more hours per day.
2009-10 Target:	56%	2009-10 Actual:	63%
Result: Indicator met.
The results of the annual client survey, undertaken in June 2010 indicated that approximately 291,392 clients (63 per cent of fitted voucher clients) were using their devices for more than five hours per day. This measure indicates the proportion of fitted clients who gain a significant benefit from their devices, but is not comparable with the indicator of the usage of hearing devices for the Rehabilitation Plus population, as it includes a wider population of clients using their devices over a longer period.

Top of page

Outcome 7 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 7.1: Hearing Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	345,477	342,691	( 2,786)	357,766
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	9,224	9,792	568	7,809
Revenues from other sources	140	192	52	147
Unfunded depreciation expense¹	-	-	-	184
Operating loss / (surplus)	-	5	5	-
Total for Program 7.1	354,841	352,680	( 2,161)	365,906
Outcome 7 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	345,477	342,691	( 2,786)	357,766
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	9,224	9,792	568	7,809
Revenues from other sources	140	192	52	147
Unfunded depreciation expense¹	-	-	-	184
Operating loss / (surplus)	-	5	5	-
Total Expenses for Outcome 7	354,841	352,680	( 2,161)	365,906
Average Staffing Level (Number)	67	68	1	63

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

| TOC | next page