Outcome 7 - Hearing Services

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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

Major Achievements

• Implementing new arrangements for hearing services vouchers with an extension of the validating period from two to three years for eligible people.
• Expanded access to services under the Community Service Obligations to enable young adults in the 21 to 25 year age group to receive services.

Challenges

• Undertaking a comprehensive review of current arrangements between the Department and hearing device manufacturers to ensure continued delivery of high quality, cost-effective devices.
• Encouraging increased interest in, and number of applications for, research into hearing loss prevention through the Hearing Loss Prevention Program.

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.

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 and management.

Support Access to Quality Hearing Services

Supporting eligible clients to manage their hearing loss and better engage in the wider community is a corner stone of the Hearing Services Program. In 2011-12, 616,639 eligible clients received hearing services vouchers for free hearing assessments, hearing rehabilitation and, where clinically appropriate, free hearing devices.

To ensure that the hearing devices provided under the Program are of a high quality, devices are obtained for the Program under a Deed of Standing Offer, between the Department and hearing device manufacturers. The current Deed commenced in April 2009 and provides a range of features for the hearing devices available under the Program and ensures clients are fitted with the latest hearing device technology.

The current Deed was extended to 31 December 2013 to allow the Department to undertake a comprehensive review of current arrangements to ensure that the Program continues to deliver high quality devices in a cost-effective manner. This process will involve significant consultation and research over the next 18 months and will examine potential changes to arrangements for provision of devices under the Program.

The Voucher Program is a demand-driven program and the numbers of clients accessing the Program was less than expected but has still grown compared to 2010-11. In 2011-12, 383,737 people received clinical services, including audiological assessments and hearing aid fittings, under the Voucher Program, compared with 360,500 people in 2010-11.

The Voucher Program is a demand-driven program and the numbers of clients accessing the Program was less than expected but has still grown compared to 2010-11. In 2011-12, 462,326 people received supporting services (such as batteries and maintenance) under the Voucher Program. While less than the 2011-12 target, it is an increase from 360,500 people in 2010-11.

Uptake of Rehab Plus was slower than predicted. In 2011-12, 2,012 people received Rehab Plus. This is a decrease from 2,508 people assisted in 2010-11. The Department is closely monitoring the uptake of Rehab Plus and engaged in extensive consultation with hearing services providers throughout 2011-12 to explore ways of improving access to rehabilitation services.

In 2011-12, the Department provided additional funding to Australian Hearing, the government hearing services provider, to deliver services to eligible clients with special needs including children, Indigenous adults, and adults with complex needs. Australian Hearing reports to the Department on the timeliness and quality of service delivery, in accordance with the Memorandum of Understanding (MoU). Consistent with the agreed standards in the MoU, in 2011-12 this included prioritisation of paediatric clients, in particular, newly diagnosed children and, in response to the expansion of eligibility to clients aged 21 to 25 from 1 January 2012, targeted communications and appointments for these clients.

The Voucher Program is a demand-driven program and the number of new clients accessing the Program was less than expected. The Hearing Services Program received 127,377 hearing service voucher application from new clients in 2011-12, slightly less than 2010-11 when 127,777 applications from new clients were received.

The Voucher Program is a demand-driven program and the number of return clients accessing the Program was less than expected but has still grown compared to 2010-11. The Hearing Services Program received 243,328 hearing service voucher applications in 2011-12 from return clients (clients who have received at least one hearing service voucher previously), compared with 195,350 applications from return clients in 2010-11.

Throughout 2011-12, the Department continued to deliver client services, including application processing and provision of telephone information services for program clients and service providers, within benchmark time frames.

The average number of working days for hearing service voucher application forms to be processed in 2011-12 was 6.5. This was reduced from 11.5 working days in 2010-11 due to successful and efficient restructuring of departmental processes.

Call centre calls were answered with an average wait time of 2.0 minutes compared to an average of 4.3 minutes in 2010-11. Call centre staff are monitored for accuracy of information provided and minimal complaints are received regarding this service.

Growth in the number of sites registered was slightly less than anticipated. In 2011-12 there were 2,344 sites registered under the Voucher Program, compared with 2,230 in 2010-11.

The majority of contracted hearing service providers operated in accordance with their contractual and legislative obligations. Considerable work was undertaken in 2011-12 to identify key risk indicators to inform the move towards a risk-based audit and compliance framework from 1 July 2012 including consultation with the hearing services sector on the proposed approach. Monitoring and evaluation strategies will be implemented in 2012-13. Desk-top audits of hearing service providers continue in the interim with site audits initiated as a result of identified serious breaches.

Data is not collected on an annual basis. Data from the 2010 Rehabilitation Plus Survey found that 62% of fitted clients used their aid(s) for four or more hours per day, which is the international standard for hearing aid usage. Future data collection will be based on the four hour usage level.

Better Targeting of Government Resources

In 2011-12, the Department implemented a number of reforms to the Hearing Services Program, resulting in enhanced client access to services. From 1 January 2012:

• the life of hearing services vouchers was extended from two years to three years to better align with clinical need and enhance efficiency. Voucher holders can access a range of hearing services for little or no cost, throughout the life of the voucher;
• in implementing the three year voucher measure, the Department revised administrative arrangements such as the provider contract, regulations regarding practitioners and clinical support documents, reducing the regulatory burden on hearing service providers, while maintaining client protections. These revised arrangements took effect from 1 July 2012. Arrangements to help smooth the transition to the three year voucher were also implemented, following consultation with the hearing services sector. These arrangements will be monitored throughout 2012-13;
• young adults, who are eligible, can now receive hearing services appropriate to their needs (including rehabilitation, hearing devices, and cochlear speech processor upgrades) until they reach their 26th birthday, supporting them to complete their education or establish themselves in the workforce; and
• clients with special needs, including children, some Indigenous Australians and people living in remote areas, can access the services they require in a more timely manner. This includes cochlear support for eligible children and young adults.

Service provision and expenditure to special needs groups in 2011-12 was consistent with planning and clinical criteria. Australian Hearing provided devices that encompass technology and features best suited to a client’s individual communication and audiological requirement, underpinned by clinical need.

Initial work has been undertaken. Broad consultation with the sector has commenced and will continue until August 2013. These consultations will inform consideration of rehabilitation options into the future. The review is expected to be completed by September 2013.

Monitoring of the impact of the threshold indicates 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 (prior to the measure being introduced) to 3.8% in 2011-12.

In 2011-12, 129,085 clients were fitted with a device, of these, 123,744 (96%) clients had a hearing loss greater than 23 decibels.

Supporting Ongoing Research into Hearing Loss Prevention

The Department continued to support ongoing research into hearing loss prevention through the Hearing Loss Prevention Program (HLPP) and through the provision of funding to the National Acoustic Laboratories. The HLPP supports research into measures to reduce the incidence of preventable hearing loss. The Program targets Aboriginal and Torres Strait Islander peoples, young people and those in the workplace. The National Health and Medical Research Council (NHMRC) administers the HLPP on behalf of the Department.

Fourteen research projects have been funded under the HLPP since 2008-09, with four projects being funded in 2011-12. Projects cover a range of issues, including 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. The Department will work closely with the NHMRC during 2012-13 to facilitate enhanced access by interested researchers to HLPP funding.

While progress reports have been submitted by grant recipients, they have frequently failed to address all of the necessary issues and the Department has had to seek further information or clarification. The Department will continue to work with grant recipients to enhance their understanding of their reporting and accountability obligations.

Two research and prevention projects were finalised in 2011-12, both were completed by the due date and have been published.⁹⁴ The remaining six projects are expected to be completed by December 2012.

Whole of Program Performance Information

Two projects funded under the Hearing Loss Prevention Program in 2011-12 produced significant research reports that will improve the knowledge base on preventable hearing loss in respect of the source and impact of noise exposure in young people.⁹⁵

There has been significant stakeholder engagement throughout 2011-12, particularly on the implementation of the Hearing Services Program Budget measures. This included face-to-face consultations around Australia to discuss the implementation of the 2011-12 Budget measures; regular meetings with industry and consumer peak bodies; and online consultations on program documentation and directions. Input received from the sector was taken into account in revising program documentation and directions. In addition, the Hearing Services Consultative Committee provided advice to the Department and the Minister on a range of issues.

The Hearing Services Program is demand driven and the number of clients accessing the Program in 2011-12 was less than expected, resulting in a slightly lower than anticipated budget expenditure.

Outcome 7 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ’Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

90. The wording for this deliverable was refined in the 2011-12 Portfolio Additional Estimates Statements to improve clarity.
91. The wording for this deliverable was refined in the 2011-12 Portfolio Additional Estimates Statements to improve clarity.
92. The wording for this deliverable was refined in the 2011-12 Portfolio Additional Estimates Statements to improve clarity.
93. The wording for this deliverable was refined in the 2011-12 Portfolio Additional Estimates Statements to improve clarity.
94. Available at www.health.gov.au/internet/main/publishing.nsf/Content/health-hear-policyparameters
95. Available at www.health.gov.au/internet/main/publishing.nsf/Content/health-hear-policyparameters

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