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

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Outcome Strategy

Outcome 7 aims to reduce the incidence of avoidable hearing loss in the Australian community and the consequence of hearing loss for eligible people, and provide access to high quality hearing services and devices. 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 major activities and performance indicators published in the Outcome 7 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 7 was managed in 2010-11 by the Regulatory Policy and Governance Division.

Program Name Program Objectives in 2010-11
Program 7.1:
Hearing Services
Support access to quality hearing services for eligible clients.
Provide better targeted hearing services.
Support research into hearing loss prevention.

Program Name	Program Objectives in 2010-11
Program 7.1: Hearing Services	Support access to quality hearing services for eligible clients. Provide better targeted hearing services. Support research into hearing loss prevention.

Major Achievements

Delivered services to clients within existing service benchmarks. The average number of working days to process hearing service voucher applications was 11.5 days in 2010-11 (compared to a service benchmark of 14 working days) and call centre calls answered with an average wait time of 4.3 minutes (compared to an average of 8.7 minutes in 2009-10).
Provided advice to Government on its response to the Senate Inquiry into Hearing Health in Australia, which resulted in several 2011-12 Budget measures that had direct benefits to the community. This included additional funding under the Hearing Services Program for special needs clients and the extension of eligibility for the Community Services Obligation component of the Program from 21 to up
to 26 year olds.

Challenges

The delivery of client application processing and call centre services within benchmarks. Call centre phone calls increased by over 9,000 calls from 2009-10 to 2010-11. In November 2010, voucher processing times and call centre wait times reached 18 working days and 5.9 minute call wait times, respectively. However, processing functions were brought within benchmarks by December 2010 following internal supplementation being made available for staff resources. Additional resourcing meant that average call centre times were reduced from an average wait time of 8.7 minutes in 2009-10 to 4.3 minutes in 2010-11.
Compliance activities were scaled down to target high risk cases, and non-client functions such as the annual client survey and secretariat support for high level advisory meetings were deferred in 2010-11,
as staffing resources were redirected to core client activities such as application processing, call centre operations, practitioner and site registrations, provider accreditation and contracting. Activities were targeted to ensure client needs remained the highest priority and that safety nets were maintained.

Trends

Figure 2.4.7.1: Number of clients receiving hearing services, Australian Government Hearing Services Voucher Program, by Financial Year, 2007-08 to 2013-14

Figure 2.4.7.1: Number of clients receiving hearing services, Australian Government Hearing Services Voucher Program, by Financial Year, 2007-08 to 2013-14
Text version of this chart

Source: Office of Hearing Services database, unpublished.

Clinical services provided under the Voucher Program include hearing assessments, the fitting of hearing devices, or existing hearing aid adjustments. Supplementary services provided under the Voucher Program include repairs or maintenance services or the provision of spare hearing aids. Where a client has received both clinical services and supplementary services in the same year, they have only been counted in clinical services.

Program 7.1: Hearing Services

Program 7.1 aims to support access to quality hearing services for eligible clients, provide better targeted hearing services and support research into hearing loss prevention.

Support Access to Quality Hearing Services

Ensure Eligible Clients Have Access to Free Hearing Services

During 2010-11 the department continued to extend benefits to the growing numbers of Australians with a hearing impairment. Eligible clients of the Hearing Services Program received vouchers for free hearing assessments, hearing rehabilitation, and free hearing devices where clinically appropriate. This support mitigates against the impact of their hearing loss and ensures the ability of clients to participate in the wider community. In 2010-11 there were 599,581 clients who received a service through the Australian Government Hearing Services Program.

Qualitative Deliverable:	Provide clients with advice on voucher services.
2010-11 Reference Point:	Timely and accurate advice provided to clients.
Result: Deliverable substantially met.
During 2010-11 the Client Contact Line answered phone calls with an average wait time of 4.3 minutes compared to the 2009-10 average of 8.7 minutes. The Client Applications Team processed applications for a hearing service voucher within an average of 11.5 days of receipt of a correctly completed application (service benchmark of 14 working days). This was down from the 2009-10 average of 17.7 working days.
Qualitative Deliverable:	Provide appropriate services to eligible clients with special needs.
2010-11 Reference Point:	Delivery of quality services to clients with special needs in a timely manner.
Result: Deliverable met.
In 2010-11 the department continued funding Australian Hearing (the government service delivery agency) to deliver services to eligible clients with special needs, including children, Indigenous adults and adults with complex needs. These services were provided within agreed standards and timeframes as set out in the Memorandum of Understanding between the department and Australian Hearing.
Quantitative Deliverable:	Number of sites registered to provide services under the Hearing Services Program.
2010-11 Target:	2,100	2010-11 Actual:			2,230
Result: Deliverable met.
In 2010-11 there were 2,230 sites registered under the Australian Government Hearing Services Program. This compares with 2,131 sites in 2009-10 and 2,037 in 2008-09.
Quantitative Deliverable:	Number of people receiving hearing services.
2010-11 Target:	596,706	2010-11 Actual:			599,581
Result: Deliverable met.
In 2010-11 there were 599,581 people who received hearing services.

Quantitative KPI:	Average number of working days taken to issue vouchers to eligible clients.
2010-11 Target:	14		2010-11 Actual:	11.5
Result: Indicator met.
The average number of working days for hearing service voucher application forms to be processed in 2010-11 was 11.5. This was down from 17.7 in 2009-10.
Quantitative KPI:	Maintain or increase the percentage of fitted clients who use their device(s) for five or more hours per day.
2010-11 Target:	56%		2010-11 Actual:	Not applicable
Result: Not applicable.
The data for this KPI is unavailable as the department did not conduct the annual client survey during 2010-11 as staffing resources were redirected to core client activities including voucher application processing and call centre operations.
Qualitative KPI:	Hearing service providers operate in accordance with their contractual and legislative obligations.
2010-11 Reference Point:	Investigation of issues raised by clients and appropriate remedial action by clinical support staff demonstrates that providers meet their requirements.
Result: Indicator met.
Audited outcomes found that the majority of hearing service providers operate in accordance with their contractual and legislative obligations. Remedial action taken on exceptions resulted in establishing compliance by providers.

Application Processing

The department improved its administrative processes to support faster services for the increasing numbers of clients and more timely information to providers. IT improvements to automate existing manual processing commenced in 2010-11 and will continue as a multi-stage project with anticipated completion in 2015-16.

Quantitative KPI:	Number of applications received per year.
2010-11 Target:	337,370	2010-11 Actual:	330,166
Result: Indicator substantially met.
The Hearing Services Program received 330,166 hearing service voucher applications during 2010-11.

In 2010-11 the department reviewed its Rehabilitation Plus service, which is provided to clients fitted with a free device for the first time to ensure they know how to use their hearing aids effectively. The review was conducted by an external consultancy and its final report was delivered to the department at the end of June 2011. The department will be reviewing the report recommendations in early 2011-12 and consult with stakeholders on proposed future actions.

Quantitative Deliverable:	Number of clients accessing rehabilitation services.
2010-11 Target:	4,540	2010-11 Actual:	2,508
Result: Deliverable not met.
Since the commencement of Rehabilitation Plus in 2008, the rate of clients claiming under Rehabilitation Plus is at a consistent rate with: 3.79% in 2008-09, 5.5% in 2009-10 and 4.5% in 2010-11. A review of the program, to identify barriers and enablers to the service, was undertaken in May-June 2011, for policy consideration early in 2011-12.

Ensure Program Clients Receive Quality Services

The department ensures that clients continue to receive quality services through the accreditation, audit and compliance functions to monitor hearing services providers. The department also responds to client issues, including complaints, both in writing and through the Client Contact Line.

Increased demand for services from the Client Contact Line meant that in 2010-11 clients contacting the Line had to wait an average of just 4.3 minutes compared to an average call wait time of 8.7 minutes in 2009-10.

In 2010-11 the department conducted a review of the Hearing Services Program’s Audit and Compliance Framework, with a view to ensuring best practice in audit and compliance procedures. In line with the recommendations of the review, the department will seek policy approval to move to a risk based audit model from 2011-12.

Better Targeting of Government Resources

From 1 July 2010, the department implemented the Minimum Hearing Loss Threshold (MHLT) to ensure that hearing services are more closely targeted to clients’ clinical needs. The measure ensures that only clients who have hearing loss outside of the normal range are eligible for a subsidised device to be fitted. A wide range of exception criteria apply so that people in exceptional circumstances are not disadvantaged, resulting in the measure being well accepted with very few complaints.

Qualitative KPI:	Provision of hearing devices targeted to clinical need.
2010-11 Reference Point:	Qualified practitioners operate within the legislated exemption criteria.
Result: Indicator met.
Monitoring of the impact of the threshold has indicated that it is achieving its aim of better targeting services. The average percentage of device fittings to new clients with a hearing loss below the threshold reduced from 8% in 2009-10 to 3.7% in 2010-11, indicating the MHLT is having the desired impact on better targeting of hearing device provision to those with the greatest clinical need.
Quantitative KPI:	Percentage of clients fitted with a hearing device with hearing loss greater than 23 decibels.
2010-11 Target:	95%	2010-11 Actual:	95.6%
Result: Indicator met.
In 2010-11 there were 140,841 clients fitted with a device, of these, 134,676 clients were with a hearing loss greater than 23 decibels. This is 95.6% of all clients fitted.

Support Ongoing Research into Hearing Loss Prevention

Through the Hearing Loss Prevention Program (HLPP), the department supports research into measures to reduce the incidence of preventable hearing loss. The program targets Aboriginal and Torres Strait Islander people, young people and those in the workplace.
Ten research projects have been funded under the HLPP since 2008-09. During 2010-11, the department continued to support eight of the original ten research projects addressing various aspects of preventable hearing loss. This research focused on identifying and reducing the sources of noise exposure in children and young adults and measures to prevent and treat otitis media (middle ear infection) in Indigenous children.

Two of ten funded research projects were finalised in 2010-11, a third project has produced a major research deliverable. ⁸⁰ The ‘Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations’ project was undertaken by the Menzies School of Health Research. The ‘Lifetime profiles of exposure to sound – what is a safe noise exposure’ and ‘Prevalence of hearing loss and its relationship to leisure-sound exposure’ projects were conducted by the National Acoustic Laboratories. As required in the conditions of funding, in 2010-11 the researchers have disseminated the reports widely to support community knowledge and individual action to prevent hearing loss.

Quantitative KPI:	Existing research and prevention projects are completed in the required timeframes and the results are disseminated widely.
2010-11 Target:	100%	2010-11 Actual:	67%
Result: Indicator substantially met.
Two of the three research and prevention projects that were planned to be finalised in 2010-11 were completed by the due date. Work on the remaining project has been of a high standard with the delay caused by competing priorities of a collaborator to the researcher. This remaining project is expected to be finalised by the end of 2011.

For funding available in 2010-11, the National Health and Medical Research Council is administering the HLPP for the department under an Memorandum of Understanding arrangement. Final grant applications closed in April 2011 and are likely to be announced in December 2011.

Quantitative Deliverable:	Progress reports submitted from existing grant recipients as per agreement.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Deliverable met.
All fifteen progress reports that were due during 2010-11 were provided at the standard required.
Qualitative KPI	Ensure research findings are published in accordance with contract requirements.
2010-11 Reference Point:	Contract requirements of publishing are met.
Result: Indicator met.
All hearing loss prevention projects were published and disseminated information in accordance with their contract requirements. In addition, two completed projects and a number of current projects exceeded their contracted requirements in terms of report dissemination requirements. Dissemination actions included conference presentations, published research papers in peer reviewed journals, formal publications and on the internet.

Whole of Program Performance Information

Qualitative Deliverable:	Produce relevant and timely evidence‑based policy research.
2010-11 Reference Point:	Relevant evidence‑based policy research produced in a timely manner.
Result: Deliverable substantially met.
Three projects funded from the Hearing Loss Prevention Program produced significant research reports in 2010-11. Two of the three projects were completed when due in 2010-11 and will significantly improve the knowledge base on preventable hearing loss in respect of the source and impact of noise exposure in young adults. The otitis media clinical care guidelines were updated to ensure that treatment options are based on the most current research available.

Qualitative Deliverable:	Stakeholders participate in program development through a range of avenues.
2010-11 Reference Point:	Stakeholders participated in program development through avenues such as regular consultative committees, conferences, stakeholder engagement forums, surveys, submissions on departmental discussion papers and meetings.
Result: Deliverable substantially met.
In 2010-11, the department consulted with clients, the hearing services industry, hearing services professional bodies, consumer representative organisations, Australian Hearing and other Government departments in relation to a variety of hearing services matters including the Government’s response to the Senate Inquiry into Hearing Health in Australia and practitioner registration matters. This consultation was conducted through face to face meetings, electronic bulletins and invitations for submissions/feedback. The department did not conduct a client survey or convene a meeting of a ministerial advisory committee, due to a decrease in the Office’s departmental budget and resources being redirected to direct client functions due to increased client demand.
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	≤0.5%	2010-11 Actual:	-4.52%
Result: Deliverable not met.
In 2010-11, the actual administered expenses were $358,138,000, which was 4.52% lower than budgeted. The Hearing Services Program is a demand driven program and the expected growth rate of clients in 2010-11 was based on the pattern of the growth in the 4th quarters of 2008-09 and 2009-10. However, the growth did not follow the same trajectory as previous years. Less people applied in 2010-11 than the previous year, and of those who did apply a lower percentage were eligible than the previous year; possibly due to recovery for the global financial crisis.

Outcome 7 – Financial Resources Summary

	(A) Budget Estimate¹ 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 7.1: Hearing Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	375,098	358,137	(16,961)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	9,321	9,234	(87)
Revenues from other sources (s31)	163	143	(20)
Unfunded depreciation expense	212	263	51
Operating loss / (surplus)	-	1	1
Total for Program 7.1	384,794	367,778	(17,016)
Outcome 7 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	375,098	358,137	(16,961)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	9,321	9,234	(87)
Revenues from other sources (s31)	163	143	(20)
Unfunded depreciation expense	212	263	51
Operating loss / (surplus)	-	1	1
Total expenses for Outcome 7	384,794	367,778	(17,016)
Average Staffing Level (Number)	64	64	0
¹ Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

⁸⁰Finalised Hearing Loss Prevention Program reports are available at: www.health.gov.au/hear

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